| Entity Name: | DAVID A. THEIS, D.D.S., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Jul 1982 (43 years ago) |
| Document Number: | F83318 |
| FEI/EIN Number | 592201505 |
| Address: | 1674 PROVIDENCE BLVD., DELTONA, FL, 32725 |
| Mail Address: | 1156 Key Largo Circle, Port Orange, FL, 32128, US |
| ZIP code: | 32725 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740381698 | 2006-09-25 | 2020-08-22 | 1674 PROVIDENCE BLVD, DELTONA, FL, 327254961, US | 1674 PROVIDENCE BLVD, DELTONA, FL, 327254961, US | |||||||||||||||||||
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| Phone | +1 386-789-5100 |
| Fax | 3867895116 |
Authorized person
| Name | DR. DAVID ALAN THEIS |
| Role | OWNER, PRESIDENT |
| Phone | 3867895100 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN 5761 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| THEIS, DAVID | Agent | 1674 PROVIDENCE BLVD, DELTONA, FL, 327254927 |
| Name | Role | Address |
|---|---|---|
| THEIS, DAVID | President | 1674 PROVIDENCE BLVD, DELTONA, FL, 32725 |
| Name | Role | Address |
|---|---|---|
| THEIS, DAVID | Director | 1674 PROVIDENCE BLVD, DELTONA, FL, 32725 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-03-17 | No data | No data |
| REINSTATEMENT | 1989-11-27 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1989-10-13 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
