| Entity Name: | BOPP AND TARVER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Nov 2009 (15 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 09 Dec 2019 (5 years ago) |
| Document Number: | L09000112485 |
| FEI/EIN Number | 271370820 |
| Address: | 1111 N. PARKWAY FRONTAGE ROAD, LAKELAND, FL, 33803, US |
| Mail Address: | 1111 N. PARKWAY FRONTAGE ROAD, LAKELAND, FL, 33803, US |
| ZIP code: | 33803 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023318052 | 2010-10-25 | 2010-10-25 | 1111 N PARKWAY FRONTAGE RD, LAKELAND, FL, 338030400, US | 1111 N PARKWAY FRONTAGE RD, LAKELAND, FL, 338030400, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 863-644-2408 |
| Fax | 8636468493 |
Authorized person
| Name | MRS. DEBBIE L ADRIAN |
| Role | OFFICE MANAGER |
| Phone | 8636442408 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN5979 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN17195 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 076621600 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BOPP AND TARVER PLLC 401(K) P/S PLAN | 2023 | 271370820 | 2024-06-28 | BOPP AND TARVER PLLC | 25 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-27 |
| Name of individual signing | JAIME GARRETT |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| TARVER JORDAN | Agent | 1111 N. PARKWAY FRONTAGE ROAD, LAKELAND, FL, 33803 |
| Name | Role | Address |
|---|---|---|
| SCHEPS S. AARON | Manager | 1111 N. PARKWAY FRONTAGE ROAD, LAKELAND, FL, 33803 |
| TARVER E. JORDAN | Manager | 1111 N. PARKWAY FRONTAGE ROAD, LAKELAND, FL, 33803 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2019-12-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-12-09 | TARVER, JORDAN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-01-12 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-23 |
| LC Amendment | 2019-12-09 |
| ANNUAL REPORT | 2019-01-09 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-01-05 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7503568303 | 2021-01-28 | 0455 | PPS | 1111 N Parkway Frontage Rd, Lakeland, FL, 33803-0400 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
