|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
2023
|
462575359
|
2024-07-29
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
11
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6064322773
|
| Plan sponsor’s
address |
308 HAMBLEY BLVD., PIKEVILLE, KY, 41501
|
Signature of
| Role |
Plan administrator |
| Date |
2024-07-29 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2024-07-29 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
2022
|
462575359
|
2023-06-16
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
10
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6064322773
|
| Plan sponsor’s
address |
308 HAMBLEY BLVD., PIKEVILLE, KY, 41501
|
Signature of
| Role |
Plan administrator |
| Date |
2023-06-16 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2023-06-16 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
2021
|
462575359
|
2022-06-13
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6064322773
|
| Plan sponsor’s
address |
308 HAMBLEY BLVD., PIKEVILLE, KY, 41501
|
Signature of
| Role |
Plan administrator |
| Date |
2022-06-09 |
| Name of individual signing |
AUNDREA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2022-06-09 |
| Name of individual signing |
AUNDREA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
2020
|
462575359
|
2021-07-29
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6064322773
|
| Plan sponsor’s
address |
308 HAMBLEY BLVD., PIKEVILLE, KY, 41501
|
Signature of
| Role |
Plan administrator |
| Date |
2021-07-29 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2021-07-29 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
2019
|
462575359
|
2020-07-28
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6064322773
|
| Plan sponsor’s
address |
308 HAMBLEY BLVD., PIKEVILLE, KY, 41501
|
Signature of
| Role |
Plan administrator |
| Date |
2020-07-28 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2020-07-28 |
| Name of individual signing |
JOSHUA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
2018
|
462575359
|
2019-07-16
|
PIKEVILLE PEDIATRIC DENTISTRY, PLLC
|
6
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6064322773
|
| Plan sponsor’s
address |
308 HAMBLEY BLVD., PIKEVILLE, KY, 41501
|
Signature of
| Role |
Plan administrator |
| Date |
2019-07-16 |
| Name of individual signing |
AUNDREA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2019-07-16 |
| Name of individual signing |
AUNDREA RALEIGH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
