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Heritage Family Dental, PLLC

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Company Details

Name: Heritage Family Dental, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 05 May 2021 (4 years ago)
Business ID: 1279618
ZIP code: 39355
County: Clarke
State of Incorporation: MISSISSIPPI
Principal Office Address: 303 S Archusa Ave, #AQuitman, MS 39355

Agent

Name Role Address
Cogency Global Inc. Agent 248 E CAPITOL STREET, SUITE 840, JACKSON, MS 39201

Organizer

Name Role Address
Haden L Anderson Organizer 4358 Lincoln Road Ext Suite 20, Hattiesburg, MS 39402

Manager

Name Role Address
Terry Lake Garner Manager 147 Waterford Place, Hattiesburg, MS 39402

National Provider Identifier

NPI Number:
1699358739
Certification Date:
2021-05-05

Authorized Person:

Name:
KELLY MILLER
Role:
CREDENTIALING SPECIALIST
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-01-30 Annual Report For Heritage Family Dental, PLLC
Amendment Form Filed 2024-08-09 Amendment For Heritage Family Dental, PLLC
Annual Report LLC Filed 2024-01-23 Annual Report For Heritage Family Dental, PLLC
Annual Report LLC Filed 2023-07-25 Annual Report For Heritage Family Dental, PLLC
Annual Report LLC Filed 2022-09-19 Annual Report For Heritage Family Dental, PLLC
Notice to Dissolve/Revoke Filed 2022-09-05 Notice of Intent to Dissolve: AR: Heritage Family Dental, PLLC
Formation Form Filed 2021-05-04 Formation For Heritage Family Dental, PLLC

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Date of last update: 26 May 2025

Sources: Company Profile on Mississippi Secretary of State Website