| Name: | Fisher Dental LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Apr 2023 (2 years ago) |
| Entity Number: | 001-076-585 |
| Register Number: | 001076585 |
| County: | Pickens |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 106 5th Street NEAliceville, AL 35442 |
| Registered Office Street Address ZIP Code: | 35442 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144911785 | 2023-05-16 | 2023-05-16 | 106 5TH ST NE, ALICEVILLE, AL, 354422200, US | 106 5TH ST NE, ALICEVILLE, AL, 354422200, US | |||||||||||||||||||||
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| Phone | +1 205-373-8726 |
| Fax | 2053738724 |
Authorized person
| Name | DR. LILLIE FISHER |
| Role | OWNER/DENTIST |
| Phone | 2567141645 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 219421 |
| State | AL |
| Name | Role |
|---|---|
| Fisher, Lillie M DMD | Agent |
| Name | Role | Address |
|---|---|---|
| Macoy, Mark W | Organizer | 300 Vestavia Parkway, Suite 2300Vestavia Hills, AL 35216 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
