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KENTUCKY DENTAL PROFESSIONALS, P.S.C.

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Company Details

Name: KENTUCKY DENTAL PROFESSIONALS, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 05 Feb 2008 (18 years ago)
Organization Date: 05 Feb 2008 (18 years ago)
Last Annual Report: 29 May 2024 (a year ago)
Organization Number: 0684810
Industry: Health Services
Number of Employees: Medium (20-99)
Principal Office: 1200 NETWORK CENTRE DRIVE, #2, EFFINGHAM, IL 62401
Place of Formation: KENTUCKY
Authorized Shares: 1000

Incorporator

Name Role
CLARENCE G. JUNG Incorporator

Registered Agent

Name Role
CORPORATION SERVICE COMPANY Registered Agent

Shareholder

Name Role
George Jung Shareholder

Secretary

Name Role
Travis Franklin Secretary

President

Name Role
George Jung President

Director

Name Role
GEORGE JUNG Director

Assistant Secretary

Name Role
Tim Fisher Assistant Secretary

National Provider Identifier

NPI Number:
1578871877

Authorized Person:

Name:
PAM HARDIEK
Role:
INSURANCE/CREDENTIALING
Phone:

Taxonomy:

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

Contacts:

Fax:
2708274503

Assumed Names

Name Status Expiration Date
AUDUBON DENTAL & IMPLANT CENTER Active 2028-04-23
BUTTERMILK CROSSING DENTAL CENTER Inactive 2024-06-24
BUTTERMILK PIKE DENTAL CARE Inactive 2024-06-24
BUTTERMILK PIKE COSMETIC AND FAMILY DENTISTRY Inactive 2024-06-24
BUTTERMILK CROSSING DENTISTRY Inactive 2024-06-24

Filings

Name File Date
Certificate of Withdrawal of Assumed Name 2024-06-19
Certificate of Withdrawal of Assumed Name 2024-06-19
Certificate of Withdrawal of Assumed Name 2024-06-19
Certificate of Withdrawal of Assumed Name 2024-06-19
Certificate of Withdrawal of Assumed Name 2024-06-19

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Sources: Kentucky Secretary of State