| Name: | Pediatric Dental Associates of Cullman, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Dec 2017 (7 years ago) |
| Entity Number: | 000-505-529 |
| Register Number: | 000505529 |
| ZIP code: | 35244 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3000 SOUTHLAKE PARKWAY, SUITE 200BIRMINGHAM, AL 35244 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609374164 | 2018-01-30 | 2018-01-30 | 1705 MAIN AVE SW STE A, CULLMAN, AL, 350557207, US | 1705 MAIN AVE SW STE A, CULLMAN, AL, 350557207, US | |||||||||||||||||
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| Phone | +1 256-739-6000 |
Authorized person
| Name | DR. RICHARD CHAMBLISS |
| Role | OWNER |
| Phone | 2054530314 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 0005181 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HASTY, WILLIAM D JR | Organizer | 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216 |
| Name | Role |
|---|---|
| CHAMBLISS, RICHARD B. JR. | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
