| Name: | Rock Dental Alabama, PLLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Jun 2022 (2 years ago) |
| Entity Number: | 001-027-558 |
| Register Number: | 001027558 |
| County: | Montgomery |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 2 NORTH JACKSON STREET,SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811623770 | 2022-07-25 | 2024-08-22 | PO BOX 3450, LITTLE ROCK, AR, 722033450, US | 5391 MAGNOLIA TRCE, HOOVER, AL, 352444622, US | |||||||||||||||||||||||||
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| Phone | +1 501-781-2777 |
| Fax | 5017812778 |
| Phone | +1 205-584-3890 |
Authorized person
| Name | SHANEQUE PHILMON |
| Role | CREDENTIALING MANAGER |
| Phone | 5014622062 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | No |
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 6190 POWERS FERRY RD STE 600ATLANTA, GA 30339 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
