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Exceptional Dental of Long Beach LLC

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Company Details

Name: Exceptional Dental of Long Beach LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 17 Nov 2021 (4 years ago)
Business ID: 1312153
ZIP code: 39560
County: Harrison
State of Incorporation: MISSISSIPPI
Principal Office Address: 5107 Beatline Rd , Suite 800Long Beach , MS 39560

Agent

Name Role Address
Exceptional Dental of Mississippi LLC Agent 9310 US Hwy 49, Gulfport, MS 39503

Manager

Name Role Address
Exceptional Dental of Mississippi LLC Manager 9310 US Hwy 49, Gulfport, MS 39503
Darrell Bourg Manager 1 Galleria Blvd, Suite 1518, Metairie, LA 70001

Member

Name Role Address
Exceptional Dental of Mississippi LLC Member 9310 US Hwy 49, Gulfport, MS 39503

National Provider Identifier

NPI Number:
1700544871
Certification Date:
2021-12-13

Authorized Person:

Name:
MRS. SAMANTHA COATS
Role:
INSURANCE CREDENTIALING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
5043864956

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-04-15 Annual Report For Exceptional Dental of Long Beach LLC
Annual Report LLC Filed 2024-04-15 Annual Report For Exceptional Dental of Long Beach LLC
Annual Report LLC Filed 2023-04-12 Annual Report For Exceptional Dental of Long Beach LLC
Annual Report LLC Filed 2022-03-29 Annual Report For Exceptional Dental of Long Beach LLC
Formation Form Filed 2021-11-17 Formation For Exceptional Dental of Long Beach LLC

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Date of last update: 28 May 2025

Sources: Company Profile on Mississippi Secretary of State Website