| Entity Name: | BOULEVARD DENTAL ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Jan 2006 (19 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 20 Jul 2018 (7 years ago) |
| Document Number: | L06000001194 |
| FEI/EIN Number | 204038856 |
| Address: | BOULEVARD DENTAL ASSOCIATES, LLC, 10794 PINES BLVD, PEMBROKE PINES, FL, 33026, US |
| Mail Address: | 10794 PINES BLVD., SUITE 204, PEMBROKE PINES, F, 33026, US |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154814143 | 2018-06-13 | 2018-06-13 | 10794 PINES BLVD STE 204, PEMBROKE PINES, FL, 330263920, US | 10794 PINES BLVD STE 204, PEMBROKE PINES, FL, 330263920, US | |||||||||||||||||||||||||
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| Phone | +1 954-538-9993 |
| Fax | 9545389994 |
Authorized person
| Name | DR. CLAUDIO HERNANDEZ |
| Role | DOCTOR |
| Phone | 9545389993 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | DN12326 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 1427594258 |
| Number | 1427594258 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AURRECOECHEA JULIA | Agent | 10794 PINES BLVD, PEMBROKE PINES, FL, 33026 |
| Name | Role | Address |
|---|---|---|
| AURRECOECHEA JULIA | Manager | 10794 PINES BLVD., PEMBROKE PINES, FL, 33026 |
| Name | Role | Address |
|---|---|---|
| CLAUDIO HERNANDEZ DDS | Managing Member | 10794 PINES BOULEVARD, PEMBROKE PINES, FL, 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-24 | AURRECOECHEA, JULIA | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-07-31 | BOULEVARD DENTAL ASSOCIATES, LLC, 10794 PINES BLVD, #204, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-07-31 | 10794 PINES BLVD, #204, PEMBROKE PINES, FL 33026 | No data |
| LC AMENDMENT | 2018-07-20 | No data | No data |
| REINSTATEMENT | 2011-01-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CANCEL ADM DISS/REV | 2008-11-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-08-13 |
| ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2019-04-24 |
| LC Amendment | 2018-07-20 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
