| Entity Name: | DEYAB, D.D.S., PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Sep 2006 (18 years ago) |
| Document Number: | L06000093124 |
| FEI/EIN Number | 20-5722001 |
| Address: | 1034 Gateway Blvd., BOYNTON BEACH, FL, 33426, US |
| Mail Address: | 1034 Gateway Blvd., BOYNTON BEACH, FL, 33426, US |
| ZIP code: | 33426 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780376426 | 2023-05-22 | 2023-08-03 | 1034 GATEWAY BLVD STE 101, BOYNTON BEACH, FL, 334268360, US | 1034 GATEWAY BLVD STE 101, BOYNTON BEACH, FL, 334268360, US | |||||||||||||||||||||
|
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| Phone | +1 561-249-2585 |
| Fax | 5613188040 |
Authorized person
| Name | DR. TIM DEYAB |
| Role | OWNER |
| Phone | 5612492585 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1124119474 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DEYAB TIM | Agent | 1034 Gateway Blvd., BOYNTON BEACH, FL, 33426 |
| Name | Role | Address |
|---|---|---|
| DEYAB TIM | Manager | 1034 Gateway Blvd., BOYNTON BEACH, FL, 33426 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000041851 | QUANTUM DENTAL | ACTIVE | 2013-05-01 | 2028-12-31 | No data | 1034 GATEWAY BLVD, SUITE#: 101, BOYNTON BEACH, FL, 33426 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-03-11 | 1034 Gateway Blvd., Suite #101, BOYNTON BEACH, FL 33426 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-18 | 1034 Gateway Blvd., Suite #101, BOYNTON BEACH, FL 33426 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-18 | 1034 Gateway Blvd., Suite #101, BOYNTON BEACH, FL 33426 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-04-28 | DEYAB, TIM | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-02-28 |
| ANNUAL REPORT | 2019-03-14 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-03-18 |
| ANNUAL REPORT | 2015-03-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
