| Name: | Coosa County Family Dentistry, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 03 Jan 2005 (20 years ago) |
| Entity Number: | 000-238-937 |
| Register Number: | 000238937 |
| ZIP code: | 35209 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2899 LINDEN AVEBIRMINGHAM, AL 35209 |
| Authorized Capital: | $100 |
Activities
PRACTICE DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023130234 | 2007-04-06 | 2008-03-24 | PO BOX 660845, BIRMINGHAM, AL, 35266, US | RR 2 BOX 44, ROCKFORD, AL, 351369507, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-879-9761 |
| Fax | 2058796565 |
| Phone | +1 256-377-4647 |
| Fax | 2563771430 |
Authorized person
| Name | DR. DWAYNE ALBRITTON |
| Role | OWNER |
| Phone | 2058799761 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 4348 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529922440 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| ALBRITTON, DWAYNE B | Agent | PO BOX 6608445BIRMINGHAM, AL 35266-0845 |
| Name | Role | Address |
|---|---|---|
| ALBRITTON, DWAYNE B | Incorporator | PO BOX 6608445BIRMINGHAM, AL 35266-0845 |
| FOXWORTH, BILLY F JR | Incorporator | No data |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
