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  5. HAEUSSNER DENTAL GROUP, LLC

HAEUSSNER DENTAL GROUP, LLC - Florida Company Profile

Company Details

Entity Name: HAEUSSNER DENTAL GROUP, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

HAEUSSNER DENTAL GROUP, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 16 Dec 2003 (21 years ago)
Document Number: L03000055984
FEI/EIN Number 200479448

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1409 KINGSLEY AVENUE BUILDING#11, ORANGE PARK, FL, 32073
Mail Address: 1409 KINGSLEY AVENUE BUILDING#11, ORANGE PARK, FL, 32073
ZIP code: 32073
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1174642375 2007-03-28 2020-08-22 1409 KINGSLEY AVE, BLDG. #11, ORANGE PARK, FL, 320734562, US 1409 KINGSLEY AVE, BLDG. #11, ORANGE PARK, FL, 320734562, US

Contacts
Phone +1 904-264-2483
Fax 9042640474

Authorized person
Name DR. THEODORE ADRIAN HAEUSSNER
Role PRESIDENT
Phone 9042642483

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number DN 6384
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2023 200479448 2024-07-16 HAEUSSNER DENTAL GROUP, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVE., BLDG 11, ORANGE PARK, FL, 32073
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2022 200479448 2023-07-27 HAEUSSNER DENTAL GROUP, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVE., BLDG 11, ORANGE PARK, FL, 32073
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2021 200479448 2022-06-13 HAEUSSNER DENTAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVE., BLDG 11, ORANGE PARK, FL, 32073
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2020 200479448 2021-07-13 HAEUSSNER DENTAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVE., BLDG 11, ORANGE PARK, FL, 32073
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2019 200479448 2020-05-26 HAEUSSNER DENTAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVE., BLDG 11, ORANGE PARK, FL, 32073
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2018 200479448 2019-10-07 HAEUSSNER DENTAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVENUE, BLDG. 11, ORANGE PARK, FL, 320734562

Signature of
Role Plan administrator
Date 2019-10-07
Name of individual signing BRIAN D. HAEUSSNER
Valid signature Filed with authorized/valid electronic signature
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2017 200479448 2018-07-26 HAEUSSNER DENTAL GROUP, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVENUE, BLDG. 11, ORANGE PARK, FL, 320734562

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing BRIAN D. HAEUSSNER
Valid signature Filed with authorized/valid electronic signature
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2016 200479448 2017-05-24 HAEUSSNER DENTAL GROUP, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVENUE, BLDG. 11, ORANGE PARK, FL, 320734562

Signature of
Role Plan administrator
Date 2017-05-24
Name of individual signing BRIAN D. HAEUSSNER
Valid signature Filed with authorized/valid electronic signature
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2015 200479448 2016-07-14 HAEUSSNER DENTAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVENUE, BLDG. 11, ORANGE PARK, FL, 320734562

Signature of
Role Plan administrator
Date 2016-07-14
Name of individual signing BRIAN D. HAEUSSNER
Valid signature Filed with authorized/valid electronic signature
HAEUSSNER DENTAL GROUP, LLC RETIREMENT PLAN & TRUST 2014 200479448 2015-06-19 HAEUSSNER DENTAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 9042642483
Plan sponsor’s address 1409 KINGSLEY AVENUE, BLDG. 11, ORANGE PARK, FL, 320734562

Signature of
Role Plan administrator
Date 2015-06-19
Name of individual signing BRIAN HAEUSSNER, DMD
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
HAEUSSNER BRIAN Managing Member 1409 KINGSLEY AVENUE BUILDING#11, ORANGE PARK, FL, 32073
HAEUSSNER BRIAN Agent 1409 KINGSLEY AVENUE BUILDING#11, ORANGE PARK, FL, 32073

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2014-08-06 HAEUSSNER, BRIAN -

Documents

Name Date
ANNUAL REPORT 2024-04-16
ANNUAL REPORT 2023-03-31
ANNUAL REPORT 2022-04-20
ANNUAL REPORT 2021-04-24
ANNUAL REPORT 2020-03-26
ANNUAL REPORT 2019-04-18
ANNUAL REPORT 2018-04-17
ANNUAL REPORT 2017-04-05
ANNUAL REPORT 2016-04-20
ANNUAL REPORT 2015-04-29

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5958167302 2020-04-30 0491 PPP 1409 Kingsley Ave, Orange Park, FL, 32073
Loan Status Date 2021-05-06
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 58000
Loan Approval Amount (current) 58000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Orange Park, CLAY, FL, 32073-1600
Project Congressional District FL-04
Number of Employees 6
NAICS code 621210
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Unknown/NotStated
Business Type Self-Employed Individuals
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 58545.04
Forgiveness Paid Date 2021-04-19
7657738309 2021-01-28 0491 PPS 1409 Kingsley Ave Ste 11, Orange Park, FL, 32073-4562
Loan Status Date 2021-11-06
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 58000
Loan Approval Amount (current) 58000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Orange Park, CLAY, FL, 32073-4562
Project Congressional District FL-04
Number of Employees 6
NAICS code 621210
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Unknown/NotStated
Business Type Self-Employed Individuals
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 58421.1
Forgiveness Paid Date 2021-10-26

Companies related by officers

No other companies in our directory share the same officers as HAEUSSNER DENTAL GROUP, LLC

Companies related by address

No other companies in our directory share the same address as HAEUSSNER DENTAL GROUP, LLC

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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