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  5. Trussville Pediatric Dentistry, P.C.

Trussville Pediatric Dentistry, P.C.

Details

Name: Trussville Pediatric Dentistry, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 13 Jan 2006 (19 years ago)
Date of dissolution: 22 Jan 2024
Entity Number: 000-245-283
Register Number: 000245283
ZIP code: 35203
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 420 TWENTIETH ST NORTHBIRMINGHAM, AL 35203
Authorized Capital: $1,000

Activities DENTISTRY PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801077334 2007-11-27 2009-11-19 123 N CHALKVILLE RD, STE 1, TRUSSVILLE, AL, 351731376, US 123 N CHALKVILLE RD, STE 1, TRUSSVILLE, AL, 351731376, US

Contacts
Phone +1 205-655-1000
Fax 2056557196

Authorized person
Name DR. THOMAS G WILLINGHAM
Role OWNER
Phone 2056551000

Taxonomy
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 5379
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 559929290
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2021 204160011 2022-10-10 TRUSSVILLE PEDIATRIC DENTISTRY 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 4901 DEERFOOT PARKWAY, SUITE 101, TRUSSVILLE, AL, 35173
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2020 204160011 2021-08-26 TRUSSVILLE PEDIATRIC DENTISTRY 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 4901 DEERFOOT PARKWAY, SUITE 101, TRUSSVILLE, AL, 35173
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2019 204160011 2020-10-14 TRUSSVILLE PEDIATRIC DENTISTRY 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 4901 DEERFOOT PKWY, SUITE 101, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2018 204160011 2019-04-22 TRUSSVILLE PEDIATRIC DENTISTRY 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2019-04-22
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2017 204160011 2018-07-18 TRUSSVILLE PEDIATRIC DENTISTRY 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2016 204160011 2017-08-07 TRUSSVILLE PEDIATRIC DENTISTRY 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2017-08-07
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2015 204160011 2016-07-26 TRUSSVILLE PEDIATRIC DENTISTRY 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2014 204160011 2015-07-24 TRUSSVILLE PEDIATRIC DENTISTRY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2015-07-24
Name of individual signing THOMAS GLENN WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2013 204160011 2014-09-30 TRUSSVILLE PEDIATRIC DENTISTRY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 2052987462
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35773

Signature of
Role Plan administrator
Date 2014-09-30
Name of individual signing THOMAS GLENN WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2012 204160011 2013-07-10 TRUSSVILLE PEDIATRIC DENTISTRY 7
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 2052987462
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35773

Signature of
Role Plan administrator
Date 2013-07-10
Name of individual signing THOMAS GLENN WILLINGHAM

Agent

Name Role Address
POST, CHAD J Agent 361 SUMMIT BLVD SUITE 110BIRMINGHAM, AL 35243

Incorporator

Name Role Address
POST, CHAD J Incorporator 361 SUMMIT BLVD SUITE 110BIRMINGHAM, AL 35243

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
4455535002 Small Business Administration 59.041 - 504 CERTIFIED DEVELOPMENT LOANS No data No data TO ASSIST SMALL BUSINESS CONCERNS BY PROVIDING LONG TERM FINANCING THROUGH THE SALE OF DEBENTURES TO THE PRIVATE SECTOR
Recipient TRUSSVILLE PEDIATRIC DENTISTRY P.C.
Recipient Name Raw TRUSSVILLE PEDIATRIC DENTISTRY P.C.
Recipient DUNS 017292725
Recipient Address 123 NORTH CHALKVILLE ROAD., TRUSSVILLE, JEFFERSON, ALABAMA, 35173-0000, UNITED STATES
Obligated Amount 0.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 292000.00
Link View Page

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6061837008 2020-04-06 0459 PPP 4901 Deerfoot Pkwy, TRUSSVILLE, AL, 35173-2697
Loan Status Date 2021-03-13
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 224359
Loan Approval Amount (current) 224359
Undisbursed Amount 0
Franchise Name -
Lender Location ID 19133
Servicing Lender Name United Community Bank
Servicing Lender Address 200 E Camperdown Way, Greenville, SC, 29601
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address TRUSSVILLE, JEFFERSON, AL, 35173-2697
Project Congressional District AL-06
Number of Employees 16
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 453618
Originating Lender Name United Community Bank
Originating Lender Address Huntsville, AL
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 225889.81
Forgiveness Paid Date 2021-02-16

Related by officers

POST, CHAD J

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Related by address

420 TWENTIETH ST NORTHBIRMINGHAM, AL 35203

R. Matt Stephenson DMD, P.C. Project Corporate Leadership, Inc.

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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