| Entity Name: | LITTLE SMILES DENTAL OFFICE #1, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 25 Nov 2008 (16 years ago) |
| Document Number: | L08000109500 |
| FEI/EIN Number | 26-3780925 |
| Address: | 15495 EAGLE NEST LANE, SUITE #110, MIAMI LAKES, FL 33014 |
| Mail Address: | 15495 EAGLE NEST LANE, SUITE #110, MIAMI LAKES, FL 33014 |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154608370 | 2011-11-16 | 2011-11-16 | 15495 EAGLE NEST LN STE 110, MIAMI LAKES, FL, 330142242, US | 15495 EAGLE NEST LN STE 110, MIAMI LAKES, FL, 330142242, US | |||||||||||||||||||||||||
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| Phone | +1 305-698-7566 |
| Fax | 3056987565 |
Authorized person
| Name | DR. BAYARDO C CORTES |
| Role | OWNER/DENTIST |
| Phone | 3056987566 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | DN15894 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075542703 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JIRON & COMPANY, CPA, PA | Agent | 5200 SW 8TH STREET, SUITE 201B, CORAL GABLES, FL 33134 |
| Name | Role | Address |
|---|---|---|
| SPENCER, CRAIG D | MANAGER | 15495 EAGLE NEST LANE, SUITE 110 MIAMI LAKES, FL 33014 |
| CORTES, BAYARDO | MANAGER | 15495 EAGLE NEST LANE, SUITE #110 MIAMI LAKES, FL 33014 |
| Name | Role | Address |
|---|---|---|
| SPENCER, CRAIG D | MEMBER | 15495 EAGLE NEST LANE, SUITE 110 MIAMI LAKES, FL 33014 |
| CORTES, BAYARDO | MEMBER | 15495 EAGLE NEST LANE, SUITE #110 MIAMI LAKES, FL 33014 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-27 | 5200 SW 8TH STREET, SUITE 201B, CORAL GABLES, FL 33134 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-04-29 | JIRON & COMPANY, CPA, PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-02 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-02-22 |
| ANNUAL REPORT | 2015-04-10 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
