| Name: | Spanish Fort Dental Associates, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 Mar 2022 (3 years ago) |
| Entity Number: | 001-008-531 |
| Register Number: | 001008531 |
| County: | Baldwin |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 5 Audubon PlanceFairhope, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750024840 | 2022-04-15 | 2022-04-15 | 5 AUDUBON PL, FAIRHOPE, AL, 365323001, US | 6450 US HIGHWAY 90 STE D, SPANISH FORT, AL, 365279480, US | |||||||||||||||||
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| Phone | +1 251-978-6029 |
| Phone | +1 251-626-7675 |
| Fax | 2516268194 |
Authorized person
| Name | DR. JOEL D. GREEN |
| Role | DENTIST |
| Phone | 2519786028 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPANISH FORT DENTAL ASSOCIATES, LLC 401(K) | 2023 | 881271528 | 2024-10-02 | SPANISH FORT DENTAL ASSOCIATES, LLC | 9 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-02 |
| Name of individual signing | DR. JOEL D. GREEN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Green, Joel D DDS | Agent | 5 Audubon Plancefairhope, AL 36532 |
| Name | Role | Address |
|---|---|---|
| Green, Joel D DDS | Organizer | 5 Audubon Plancefairhope, AL 36532 |
| Jordan, Joseph D | Organizer | 128 N. Main Street., Suite BBelmont, NC 28012 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
