| Entity Name: | JEFFREY D. BLUM, D.D.S., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Oct 1981 (43 years ago) |
| Document Number: | F52906 |
| FEI/EIN Number | 592131999 |
| Address: | 4308 ALTON RD., SUITE #850, MIAMI BEACH, FL, 33140, US |
| Mail Address: | 4308 ALTON RD., SUITE #850, MIAMI BEACH, FL, 33140, US |
| ZIP code: | 33140 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518196013 | 2009-07-07 | 2009-07-07 | 4308 ALTON RD, SUITE 850, MIAMI BEACH, FL, 331404556, US | 4308 ALTON RD, SUITE 850, MIAMI BEACH, FL, 331404556, US | |||||||||||||||||||
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| Phone | +1 305-538-3446 |
| Fax | 3055382019 |
Authorized person
| Name | DR. JEFFREY DENNIS BLUM |
| Role | PRESIDENT |
| Phone | 3055384556 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | DN5527 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFFREY D. BLUM, D.D.S., P.A. PROFIT SHARING PLAN | 2014 | 592131999 | 2015-08-27 | JEFFREY D. BLUM, D.D.S., P.A. | 13 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 592131999 |
| Plan administrator’s name | JEFFREY D. BLUM, D.D.S., P.A. |
| Plan administrator’s address | 4308 ALTON ROAD, SUITE 850, MIAMI BEACH, FL, 33140 |
| Administrator’s telephone number | 3055384556 |
Signature of
| Role | Plan administrator |
| Date | 2015-08-27 |
| Name of individual signing | JEFFREY D BLUM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BLUM, JEFFREY D. | Agent | 4308 ALTON RD., MIAMI BEACH, FL, 33140 |
| Name | Role | Address |
|---|---|---|
| Dr. Jeffrey Dennis Blum Revocable Trust | President | 4308 ALTON RD, SUITE # 850, MIAMI BEACH, FL |
| Name | Role | Address |
|---|---|---|
| Dr. Jeffrey Dennis Blum Revocable Trust | Director | 4308 ALTON RD, SUITE # 850, MIAMI BEACH, FL |
| Name | Role | Address |
|---|---|---|
| Blum Michel | Manager | 156 2ND AVENUE, New York, NY, 10003 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000024855 | BLUM ORAL-FACIAL SURGERY ASSOCIATES | EXPIRED | 2010-03-17 | 2015-12-31 | No data | 4308 ALTON RD., SUITE 850, MIAMI BEACH, FL, 33140 |
| G09014900256 | BLUM ORAL-FACIAL SURGERY ASSOCIATES | EXPIRED | 2009-01-14 | 2014-12-31 | No data | 4308 ALTON RD., SUITE# 850, MIAMI BEACH, FL, 33140 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2011-03-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| NAME CHANGE AMENDMENT | 1988-03-14 | JEFFREY D. BLUM, D.D.S., P.A. | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
