| Name: | Premier One Implant Centers, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 20 Dec 1983 (41 years ago) |
| Date of Dissolution: | 12 Sep 2023 (2 years ago) |
| Date of Status Change: | 12 Sep 2023 (2 years ago) |
| Identification Number: | 000001558 |
| Principal Address: | 103 COMMONWEALTH AVENUE, ATTLEBORO FALLS, MA, 02763, USA |
| Purpose: | PRACTICE OF DENTISTRY AND ORAL SURGEONS |
| Historical names: |
Attleboro-Cumberland Oral Surgeons, Inc. |
NAICS
621210 Offices of DentistsThis industry comprises establishments of health practitioners having the degree of D.M.D. (Doctor of Dental Medicine), D.D.S. (Doctor of Dental Surgery), or D.D.Sc. (Doctor of Dental Science) primarily engaged in the independent practice of general or specialized dentistry or dental surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. They can provide either comprehensive preventive, cosmetic, or emergency care, or specialize in a single field of dentistry. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972545481 | 2006-06-11 | 2008-01-02 | 3353 MENDON RD, CUMBERLAND, RI, 02864, US | 3353 MENDON RD, CUMBERLAND, RI, 02864, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 401-658-2224 |
| Fax | 4016580039 |
Authorized person
| Name | JOHN F BIERNACKI |
| Role | PARTNER |
| Phone | 4016582224 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | 01614 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | 012100 |
| State | MA |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RIBC |
| Number | 86509 |
| Issuer | BCBS MA |
| Number | X10578 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ATTLEBORO-CUMBERLAND ORAL SURGEONS, INC. SH 401-K CT PSP | 2015 | 050404003 | 2016-10-05 | ATTLEBORO-CUMBERLAND ORAL SURGEONS, INC. | 14 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2016-10-05 |
| Name of individual signing | JOHN BIERNACKI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 1984-01-01 |
| Business code | 621210 |
| Plan sponsor’s address | 3353 MENDON ROAD, CUMBERLAND, RI, 02864 |
Signature of
| Role | Plan administrator |
| Date | 2016-01-06 |
| Name of individual signing | JOHN BIERNACKI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 1984-01-01 |
| Business code | 621210 |
| Plan sponsor’s address | 3353 MENDON ROAD, CUMBERLAND, RI, 02864 |
Signature of
| Role | Plan administrator |
| Date | 2015-04-07 |
| Name of individual signing | JOHN BIERNACKI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| JOHN S. DIBONA, ESQ. | Agent | 78 KENWOOD STREET, CRANSTON, RI, 02907, USA |
| Name | Role | Address |
|---|---|---|
| MARK D SCHENKMAN | PRESIDENT | 16232 1ST AVENUE PHOENIX, AZ 85045 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2021-01-01 | Attleboro-Cumberland Oral Surgeons, Inc. | Premier One Implant Centers, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202341440970 | Revocation Certificate For Failure to File the Annual Report for the Year | 2023-09-12 |
| 202337975910 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202215534710 | Annual Report | 2022-04-18 |
| 202190144100 | Annual Report | 2021-02-04 |
| 202078495300 | Articles of Amendment | 2020-12-03 |
| 202038309320 | Statement of Change of Registered/Resident Agent Office | 2020-04-22 |
| 202038297690 | Statement of Change of Registered/Resident Agent Office | 2020-04-22 |
| 202033703150 | Annual Report | 2020-02-03 |
| 201997524540 | Annual Report | 2019-06-17 |
| 201860310690 | Annual Report | 2018-03-15 |
Date of last update: 05 Apr 2025
Sources: Rhode Island Department of State
