| Entity Name: | NICEVILLE FAMILY DENTAL CENTER, P.L. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Mar 2002 (23 years ago) |
| Document Number: | L02000004926 |
| FEI/EIN Number | 030404762 |
| Address: | 1764 Osprey Cove, NICEVILLE, FL, 32578, US |
| Mail Address: | 1764 Osprey Cove, NICEVILLE, FL, 32578, US |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730297656 | 2006-08-29 | 2020-08-22 | 908 PALM BLVD S, NICEVILLE, FL, 325782603, US | 908 PALM BLVD S, NICEVILLE, FL, 325782603, US | |||||||||||||||||||||||||
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| Phone | +1 850-729-1223 |
| Fax | 8506786086 |
Authorized person
| Name | DR. RALF PETER ZAPATA |
| Role | DIRECTOR |
| Phone | 8507291223 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED CONCORDIA |
| Number | 809857 |
| Issuer | BLUE CROSS OF FLORIDA |
| Number | 34790 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NICEVILLE FAMILY DENTAL CENTER, P.L. 401(K) PLAN | 2021 | 030404762 | 2022-05-13 | NICEVILLE FAMILY DENTAL CENTER, P.L. | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-05-13 |
| Name of individual signing | RALF P. ZAPATA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 8505826218 |
| Plan sponsor’s address | 1764 OSPREY COVE, NICEVILLE, FL, 32578 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-05 |
| Name of individual signing | RALF P. ZAPATA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| PITELL LISA Y | Agent | Patriot Plaza, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| ZAPATA RALF P | Manager | 1764 OSPREY COVE, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-31 | Patriot Plaza, 1402 Cat-Mar Road, Suite B, NICEVILLE, FL 32578 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-29 | 1764 Osprey Cove, NICEVILLE, FL 32578 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-29 | 1764 Osprey Cove, NICEVILLE, FL 32578 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-01-22 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-02-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
