| Name: | SOUTH COUNTY PEDIATRIC DENTISTRY, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 23 May 2012 (13 years ago) |
| Date of Dissolution: | 30 Jul 2018 (6 years ago) |
| Date of Status Change: | 30 Jul 2018 (6 years ago) |
| Identification Number: | 000790516 |
| ZIP code: | 02882 |
| County: | Washington County |
| Principal Address: | 71 AVICE STREET, NARRAGANSETT, RI, 02882, USA |
| Purpose: | TREATMENT OF CHILDRENS DENTAL PROBLEMS |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336548130 | 2014-08-18 | 2014-08-26 | 6 LAMBERT STREET, NARRAGANSETT, RI, 028823399, US | 6 LAMBERT STREET, NARRAGANSETT, RI, 028823399, US | |||||||||||||||||||||||||
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| Phone | +1 401-789-7200 |
| Fax | 4017897205 |
Authorized person
| Name | DR. MATTHEW WESTCOTT DOWNEY |
| Role | OWNER/PEDIATRIC DENTIST |
| Phone | 4017897200 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DEN03116 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | MD85555 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| JAMES C. SULLIVAN, ESQ. | Agent | 1130 TEN ROD ROAD SUITE B-206, NORTH KINGSTOWN, RI, 02852, USA |
| Number | Name | File Date |
|---|---|---|
| 201873348020 | Revocation Certificate For Failure to File the Annual Report for the Year | 2018-07-30 |
| 201865710530 | Revocation Notice For Failure to File An Annual Report | 2018-05-15 |
| 201863600950 | Miscellaneous Filing (No Fee) | 2018-02-05 |
| 201610951340 | Annual Report | 2016-10-24 |
| 201585931590 | Annual Report | 2015-10-26 |
| 201448620430 | Annual Report | 2014-10-20 |
| 201329239610 | Annual Report | 2013-10-08 |
| 201293361380 | Articles of Organization | 2012-05-23 |
Date of last update: 17 Oct 2024
Sources: Rhode Island Department of State
