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  5. ERIC H. WALLACE, D.D.S., P.A.

ERIC H. WALLACE, D.D.S., P.A.

Company Details

Entity Name: ERIC H. WALLACE, D.D.S., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 20 Jan 1989 (36 years ago)
Date of dissolution: 03 Apr 2019 (6 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 03 Apr 2019 (6 years ago)
Document Number: K59708
FEI/EIN Number 65-0095994
Address: 600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432
Mail Address: 600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432
ZIP code: 33432
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1811148638 2008-10-10 2008-10-10 28 SE 6TH ST, BOCA RATON, FL, 334326016, US 28 SE 6TH ST, BOCA RATON, FL, 334326016, US

Contacts
Phone +1 561-391-0020
Fax 5613918863

Authorized person
Name DR. ERIC H WALLACE
Role OWNER
Phone 5613910020

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ERIC H. WALLACE, D. D. S. , P. A. 401(K) PLAN 2015 650095994 2016-11-18 ERIC H. WALLACE, D.D.S., P.A. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 5613910020
Plan sponsor’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016

Signature of
Role Plan administrator
Date 2016-11-18
Name of individual signing ERIC H WALLACE
Valid signature Filed with authorized/valid electronic signature
ERIC H. WALLACE, D.D.S., P.A. 401(K) PLAN 2015 650095994 2016-09-28 ERIC H. WALLACE, D.D.S., P.A. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 5613910020
Plan sponsor’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016

Signature of
Role Plan administrator
Date 2016-09-28
Name of individual signing ERIC H WALLACE
Valid signature Filed with authorized/valid electronic signature
ERIC H. WALLACE, D.D.S., P.A. 401(K) PLAN 2014 650095994 2015-06-30 ERIC H. WALLACE, D.D.S., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 5613910020
Plan sponsor’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016

Signature of
Role Plan administrator
Date 2015-06-30
Name of individual signing ERIC H. WALLACE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-30
Name of individual signing ERIC H. WALLACE
Valid signature Filed with authorized/valid electronic signature
ERIC H. WALLACE, D.D.S., P.A. 401(K) PLAN 2013 650095994 2014-06-05 ERIC H. WALLACE, D.D.S., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 5613910020
Plan sponsor’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016

Signature of
Role Plan administrator
Date 2014-06-05
Name of individual signing ERIC H. WALLACE
Valid signature Filed with authorized/valid electronic signature
ERIC H. WALLACE, D.D.S., P.A. 401(K) PLAN 2012 650095994 2013-06-11 ERIC H. WALLACE, D.D.S., P.A. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 5613910020
Plan sponsor’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016

Signature of
Role Plan administrator
Date 2013-06-11
Name of individual signing ERIC H. WALLACE
Valid signature Filed with authorized/valid electronic signature
ERIC H. WALLACE, D.D.S., P.A. 401(K) PLAN 2011 650095994 2012-07-12 ERIC H. WALLACE, D.D.S., P.A. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 5613910020
Plan sponsor’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016

Plan administrator’s name and address
Administrator’s EIN 650095994
Plan administrator’s name ERIC H. WALLACE, D.D.S., P.A.
Plan administrator’s address 28 S.E. 6TH STREET, BOCA RATON, FL, 334326016
Administrator’s telephone number 5613910020

Signature of
Role Plan administrator
Date 2012-07-12
Name of individual signing ERIC H. WALLACE, D.D.S.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WALLACE, ERIC H., D.D.S. Agent 600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432

President

Name Role Address
WALLACE, ERIC H., D.D.S. President 1140 SW 21st Lane, BOCA RATON, FL 33486

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2019-04-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2017-06-02 600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432 No data
REGISTERED AGENT ADDRESS CHANGED 2017-06-02 600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432 No data
CHANGE OF MAILING ADDRESS 2017-05-30 600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432 No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2019-04-03
ANNUAL REPORT 2018-01-15
Reg. Agent Change 2017-06-02
ANNUAL REPORT 2017-01-23
ANNUAL REPORT 2016-02-09
ANNUAL REPORT 2015-01-06
ANNUAL REPORT 2014-01-13
ANNUAL REPORT 2013-01-31
ANNUAL REPORT 2012-02-07
ANNUAL REPORT 2011-02-11

Related by officers

No related officers

Related by address

600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432

ROSALMARIE M. SALAZAR, D.M.D., P.A.

600 SOUTH DIXIE HIGHWAY, SUITE 200, BOCA RATON, FL 33432

ROSALMARIE M. SALAZAR, D.M.D., P.A.

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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