| Name: | ATWILL-CONROY PROVIDENCE, LLC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 22 Feb 2011 (14 years ago) |
| Identification Number: | 000585704 |
| ZIP code: | 02908 |
| County: | Providence County |
| Principal Address: | 1196 SMITH STREET, PROVIDENCE, RI, 02908, USA |
| Purpose: | TO ENGAGE IN THE PRACTICE OF DENTISTRY |
| Fictitious names: |
Atwill Conroy Dental Associates (trading name, 2011-03-23 - 2011-12-29) |
| Historical names: |
CGHE Dental, LLC |
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 | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750680435 | 2011-03-21 | 2011-03-21 | 1196 SMITH ST, PROVIDENCE, RI, 029082036, US | 1196 SMITH ST, PROVIDENCE, RI, 029082036, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 401-351-3090 |
| Fax | 4013311315 |
Authorized person
| Name | DR. KRISTOFER HAGGARTY |
| Role | MEMBER |
| Phone | 4013513090 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 2744 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 2350 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 2837 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 2663 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| ORSON AND BRUSINI LTD. | Agent | 211 QUAKER LANE SUITE 201, WEST WARWICK, RI, 02893, USA |
| Name | Role | Address |
|---|---|---|
| KRISTOFER HAGGERTY | MANAGER | 1196 SMITH STREET PROVIDENCE, RI 02908 USA |
| BAKHOUM M GIRGIS | MANAGER | 1196 SMITH STREET PROVIDENCE, RI 02908 US |
| THOMAS J HERNON | MANAGER | 1196 SMITH STREET PROVIDENCE, RI 02908 US |
| WILLIAM R CONROY JR. | MANAGER | 1196 SMITH STREET PROVIDENCE, RI 02908 US |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2014-05-06 | CGHE Dental, LLC | ATWILL-CONROY PROVIDENCE, LLC. |
| Number | Name | File Date |
|---|---|---|
| 202449988220 | Annual Report | 2024-04-02 |
| 202330276050 | Annual Report | 2023-03-08 |
| 202224359780 | Statement of Change of Registered/Resident Agent Office | 2022-10-21 |
| 202217186160 | Annual Report | 2022-05-09 |
| 202102156090 | Annual Report | 2021-09-27 |
| 202193784330 | Annual Report - Amended | 2021-03-10 |
| 202193781140 | Annual Report - Amended | 2021-03-10 |
| 202065385210 | Annual Report | 2020-10-15 |
| 202058737000 | Annual Report | 2020-09-28 |
| 201919482130 | Annual Report | 2019-09-12 |
Date of last update: 15 Oct 2024
Sources: Rhode Island Department of State
