| Entity Name: | TUSCAWILLA DENTAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 May 2004 (21 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 20 Jun 2016 (9 years ago) |
| Document Number: | L04000033268 |
| FEI/EIN Number | 201150818 |
| Address: | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL, 32141-4225, US |
| Mail Address: | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL, 32141-4225, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598930646 | 2008-04-29 | 2008-04-29 | 2102 S RIDGEWOOD AVE, STE 6, EDGEWATER, FL, 321414240, US | 2102 S RIDGEWOOD AVE, STE 6, EDGEWATER, FL, 321414240, US | |||||||||||||||||||
|
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| Phone | +1 386-423-3652 |
| Fax | 3864233653 |
Authorized person
| Name | DR. DAVID RICHARD MCCREARY |
| Role | OWNER |
| Phone | 3864233652 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN15207 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Sirivolu Surendra G | Agent | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL, 321414225 |
| Name | Role | Address |
|---|---|---|
| SIRIVOLU Surendra G | President | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL, 321414225 |
| Name | Role | Address |
|---|---|---|
| Sirivolu Aruna | Mgr | 2102 S Ridgewood Ave #11, Edgewater, FL, 32141 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-10 | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL 32141-4225 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-10 | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL 32141-4225 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-10 | Sirivolu, Surendra Gopal | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-10 | 2102 S RIDGEWOOD AVE STE 11, EDGEWATER, FL 32141-4225 | No data |
| LC AMENDMENT | 2016-06-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-02-04 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-04-24 |
| LC Amendment | 2016-06-20 |
| ANNUAL REPORT | 2016-02-29 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
