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  5. JACK A. DAVIDSON, D.D.S., M.D., PLLC

JACK A. DAVIDSON, D.D.S., M.D., PLLC - Florida Company Profile

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Company Details

Entity Name: JACK A. DAVIDSON, D.D.S., M.D., PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 08 Mar 2005 (20 years ago)
Document Number: L05000022899
FEI/EIN Number 364570822
Address: 16141 Fishhawk Blvd, Lithia, FL, 33547, US
Mail Address: 16141 Fishhawk Blvd, Lithia, FL, 33547, US
ZIP code: 33547
City: Lithia
County: Hillsborough
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
DAVIDSON JACK A Manager 16141 Fishhawk Blvd, Lithia, FL, 33547
Breen Jennifer J Auth 16141 Fishhawk Blvd, Lithia, FL, 33547
LAMBERT JUDITH S Agent 673 WEST LUMSDEN ROAD, BRANDON, FL, 33511

National Provider Identifier

NPI Number:
1548403314
Certification Date:
2025-07-09
Link:
View on NPI website

Authorized Person:

Name:
DR. JACK DAVIDSON JR.
Role:
DOCTOR
Phone:
8135711516

Taxonomy:

Selected Taxonomy:
2086S0122X - Plastic and Reconstructive Surgery Physician
Is Primary:
No
Selected Taxonomy:
1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary:
Yes

Contacts:

Phone:
+1 813-571-1516
Fax:
8135711626

Form 5500 Series

Employer Identification Number (EIN):
364570822
Plan Year:
2023
Number Of Participants:
12
Sponsors Telephone Number:
8135711516
File:
View File
Plan Year:
2022
Number Of Participants:
11
Sponsors Telephone Number:
8135711516
File:
View File
Plan Year:
2021
Number Of Participants:
13
Sponsors Telephone Number:
8139432060
File:
View File
Plan Year:
2020
Number Of Participants:
12
Sponsors Telephone Number:
8139432060
File:
View File
Plan Year:
2019
Number Of Participants:
11
Sponsors Telephone Number:
8139432060
File:
View File

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000153922 DAVIDSON SURGERY ACTIVE 2022-12-14 2027-12-31 - 16141 FISHHAWK BLVD, STE B, LITHIA, FL, 33547

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-02-07 16141 Fishhawk Blvd, Suite B, Lithia, FL 33547 -
CHANGE OF MAILING ADDRESS 2023-02-07 16141 Fishhawk Blvd, Suite B, Lithia, FL 33547 -
REGISTERED AGENT ADDRESS CHANGED 2014-01-08 673 WEST LUMSDEN ROAD, BRANDON, FL 33511 -

Documents

Name Date
ANNUAL REPORT 2024-04-08
ANNUAL REPORT 2023-02-07
ANNUAL REPORT 2022-04-06
ANNUAL REPORT 2021-02-24
ANNUAL REPORT 2020-01-21
ANNUAL REPORT 2019-03-12
ANNUAL REPORT 2018-03-27
ANNUAL REPORT 2017-04-05
ANNUAL REPORT 2016-04-20
ANNUAL REPORT 2015-04-03

USAspending Awards / Financial Assistance

Date:
2021-02-03
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
66449.00
Total Face Value Of Loan:
66449.00
Date:
2020-06-25
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
150000.00
Total Face Value Of Loan:
150000.00
Date:
2020-04-26
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
7000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-13
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
67900.00
Total Face Value Of Loan:
67900.00

Paycheck Protection Program

Jobs Reported:
8
Initial Approval Amount:
$66,449
Date Approved:
2021-02-03
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$66,449
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
$67,124.41
Servicing Lender:
Live Oak Banking Company
Use of Proceeds:
Payroll: $66,444
Utilities: $1
Jobs Reported:
7
Initial Approval Amount:
$67,900
Date Approved:
2020-04-12
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$67,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
$68,432.04
Servicing Lender:
Live Oak Banking Company
Use of Proceeds:
Payroll: $67,900

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SOUTH TAMPA PLASTIC SURGERY, PLLC
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SOUTH TAMPA PLASTIC SURGERY, PLLC, which currently Active, has registered address 16141 Fishhawk Blvd, Lithia, FL, 33547, US.
SOUTH TAMPA PLASTIC SURGERY, PLLC
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DAVIDSON INVESTMENTS, LLC, which currently Active, has registered address 16141 Fishhawk Blvd, Lithia, FL, 33547, US.
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Florida Limited Liability Co.
FISHHAWK INVESTMENTS, LLC, which currently Active, has registered address 16141 Fishhawk Blvd, Lithia, FL, 33547, US.

Date of last update: 03 Aug 2025

Sources: Florida Department of State

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