| Name: | Magnolia Springs Dental, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 20 Mar 2022 (3 years ago) |
| Entity Number: | 001-009-720 |
| Register Number: | 001009720 |
| County: | Shelby |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 3800 Corporate Woods DriveBirmingham, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295457901 | 2022-09-19 | 2022-09-19 | 12440 MAGNOLIA AVE STE 200, MAGNOLIA SPRINGS, AL, 365556434, US | 12440 MAGNOLIA AVE STE 200, MAGNOLIA SPRINGS, AL, 365556434, US | |||||||||||||||||||
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| Phone | +1 251-965-1773 |
Authorized person
| Name | DR. MATTHEW ROBERTO PISCHEK |
| Role | OWNER |
| Phone | 2512131101 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GENERAL DENTIST |
| Number | 1861985483 |
| State | AL |
| Name | Role |
|---|---|
| Reckart, Kelsey | Agent |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
