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Dental Group of Wiggins, LLC

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Company Details

Name: Dental Group of Wiggins, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 11 Oct 2021 (4 years ago)
Business ID: 1294749
ZIP code: 39402
County: Lamar
State of Incorporation: MISSISSIPPI
Principal Office Address: 4358 Lincoln Rd. Ext. #20Hattiesburg, MS 39402

Agent

Name Role Address
Terry Lake Garner Agent 4358 Lincoln Rd Ext. #20, Hattiesburg, MS 39402

Member

Name Role Address
Terry Lake Garner Member 4358 Lincoln Rd Ext. #20, Hattiesburg, MS 39402
Margaret Nichols Member 43 Milikens Bend, Hattiesburg, MS 39402

National Provider Identifier

NPI Number:
1346810306
Certification Date:
2021-06-30

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 2025-03-27 Annual Report For Dental Group of Wiggins, LLC
Annual Report LLC Filed 2024-10-08 Annual Report For Dental Group of Wiggins, LLC
Notice to Dissolve/Revoke Filed 2024-09-01 Notice of Intent to Dissolve: AR: Dental Group of Wiggins, LLC
Annual Report LLC Filed 2023-01-23 Annual Report For Dental Group of Wiggins, LLC
Reinstatement Filed 2022-12-08 Reinstatement For Dental Group of Wiggins, LLC
Admin Dissolution Filed 2022-11-28 Action of Intent to Dissolve: AR: Dental Group of Wiggins, LLC
Notice to Dissolve/Revoke Filed 2022-09-05 Notice of Intent to Dissolve: AR: Dental Group of Wiggins, LLC
Formation Form Filed 2021-07-19 Formation For Dental Group of Wiggins, LLC

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Date of last update: 27 May 2025

Sources: Company Profile on Mississippi Secretary of State Website