| Name: | Regional Dental Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 27 Jun 2012 (13 years ago) |
| Entity Number: | 000-070-357 |
| Register Number: | 000070357 |
| Historical Names: |
Bruce Young DMD, LLC
|
| ZIP code: | 36265 |
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Registered Office Street Address: | 505 PELHAM ROAD SJACKSONVILLE, AL 36265 |
Activities
DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154748218 | 2014-03-26 | 2023-04-04 | 505 PELHAM RD S, JACKSONVILLE, AL, 362652775, US | 505 PELHAM RD S, JACKSONVILLE, AL, 362652775, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-435-4464 |
| Fax | 2564352079 |
Authorized person
| Name | DR. WILLIAM BRUCE YOUNG |
| Role | OWNER |
| Phone | 2564354464 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 3308 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DELTA |
| Number | 3308 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHEILD OF ALABAMA |
| Number | 51097747 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000097747 |
| State | AL |
| Issuer | UNITED CONCORDIA |
| Number | 793127 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| YOUNG, BRUCE | Agent | 2512 BEN POOLE RD SEDECATUR, AL 35640 |
| Name | Role |
|---|---|
| YOUNG, WILLIAM B | Member |
| Name | Role | Address |
|---|---|---|
| YOUNG, BRUCE | Organizer | 2512 BEN POOLE RD SEDECATUR, AL 35640 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2014-09-30 | Name Change | Bruce Young DMD, LLC | Regional Dental Center, LLC |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3583768305 | 2021-01-22 | 0459 | PPS | 505 Pelham Rd S, Jacksonville, AL, 36265-2775 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
