| Entity Name: | H. RAYMOND KLEIN, D.D.S., P. A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 27 Aug 1969 (55 years ago) |
| Document Number: | 601330 |
| FEI/EIN Number | 591269352 |
| Address: | 943 CESERY BLVD., JACKSONVILLE, FL, 32211 |
| Mail Address: | 943 CESERY BLVD., JACKSONVILLE, FL, 32211 |
| ZIP code: | 32211 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497893697 | 2007-02-01 | 2008-07-29 | 943 CESERY BLVD, JACKSONVILLE, FL, 322115635, US | 943 CESERY BLVD, JACKSONVILLE, FL, 322115635, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-743-2000 |
| Fax | 9047258569 |
Authorized person
| Name | H. RAYMOND KLEIN |
| Role | PRES. |
| Phone | 9047432000 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN3351 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 071684700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 073459400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KLEIN,H RAYMOND | Agent | 943 CESERY BLVD., JACKSONVILLE, FL, 32211 |
| Name | Role | Address |
|---|---|---|
| KLEIN, H. RAYMOND | President | 943 CESERY BLVD., JACKSONVILLE, FL |
| Name | Role | Address |
|---|---|---|
| KLEIN, H. RAYMOND | Director | 943 CESERY BLVD., JACKSONVILLE, FL |
| KLEIN, RENEE M | Director | 943 CESERY BLVD., JACKSONVILLE, FL |
| Name | Role | Address |
|---|---|---|
| KLEIN, RENEE M | Secretary | 943 CESERY BLVD., JACKSONVILLE, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REINSTATEMENT | 1986-10-16 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1977-12-01 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
