| Entity Name: | DYNAMIC PEDIATRIC DENTISTRY FOR CHILDREN, PLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 Jan 2008 (17 years ago) |
| Document Number: | L08000005730 |
| FEI/EIN Number | 26-1756736 |
| Address: | 3305 S.E. FEDERAL HIGHWAY, STUART, FL 34997 |
| Mail Address: | 3305 S.E. FEDERAL HIGHWAY, STUART, FL 34997 |
| ZIP code: | 34997 |
| County: | Martin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013237411 | 2010-06-08 | 2010-06-08 | 3305 SE FEDERAL HWY, STUART, FL, 349974913, US | 3305 SE FEDERAL HWY, STUART, FL, 349974913, US | |||||||||||||||||||||||||
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| Phone | +1 772-221-3112 |
| Fax | 7722213175 |
Authorized person
| Name | MS. CINDY WILSON |
| Role | MMGR |
| Phone | 7722213112 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN17725 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 076508200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILSON, JUNE | Agent | 206 KELLWOOD COURT, KISSIMMEE, FL 34743 |
| Name | Role | Address |
|---|---|---|
| WILSON, CINDY | Managing Member | 3305 S.E. FEDERAL HIGHWAY, STUART, FL 34990 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-05-14 | 3305 S.E. FEDERAL HIGHWAY, STUART, FL 34997 | No data |
| CHANGE OF MAILING ADDRESS | 2009-05-14 | 3305 S.E. FEDERAL HIGHWAY, STUART, FL 34997 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-03-30 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-02-23 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-14 |
| ANNUAL REPORT | 2016-03-23 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
