| Entity Name: | DENTAL SPECIALISTS OF NORTH FLORIDA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Nov 2009 (15 years ago) |
| Document Number: | L09000113948 |
| FEI/EIN Number | 271396570 |
| Address: | 124 INLET DR, SAINT AUGUSTINE, FL, 32080, US |
| Mail Address: | 124 INLET DR, SAINT AUGUSTINE, FL, 32080, US |
| ZIP code: | 32080 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265756571 | 2010-03-16 | 2010-03-16 | 3 CYPRESS BRANCH WAY, SUITE C, PALM COAST, FL, 321648409, US | 3 CYPRESS BRANCH WAY, SUITE C, PALM COAST, FL, 321648409, US | |||||||||||||||||||
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| Phone | +1 386-445-4242 |
| Fax | 3864454247 |
Authorized person
| Name | DR. ROBERT ROY THOUSAND JR. |
| Role | OWNER/PERIODONTIST |
| Phone | 3864454242 |
Taxonomy
| Taxonomy Code | 1223P0300X - Periodontist |
| License Number | DN7967 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENTAL SPECIALISTS OF NORTH FLORIDA 401(K) | 2023 | 271396570 | 2024-07-17 | DENTAL SPECIALISTS OF NORTH FLORIDA | 22 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-17 |
| Name of individual signing | JENNI THOUSAND |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-11-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 9047941000 |
| Plan sponsor’s address | 10 SAINT JOHNS MEDICAL PARK DR STE, ST. AUGUSTINE, FL, 32086 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-21 |
| Name of individual signing | JENNI THOUSAND |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-11-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 9047941000 |
| Plan sponsor’s address | 10 SAINT JOHNS MEDICAL PARK DR STE, ST. AUGUSTINE, FL, 32086 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-13 |
| Name of individual signing | JENNI THOUSAND |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-11-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 9047941000 |
| Plan sponsor’s address | 10 SAINT JOHNS MEDICAL PARK DR STE, ST. AUGUSTINE, FL, 32086 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-02 |
| Name of individual signing | JENNI THOUSAND |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| OCONNELL WILLIAM H | Agent | 2825 LEWIS SPEEDWAY, ST AUGUSTINE, FL, 32084 |
| Name | Role | Address |
|---|---|---|
| THOUSAND ROBERT RJr. | Managing Member | 124 INLET DR, ST AUGUSTINE, FL, 32080 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000005081 | DENTAL SPECIALIST OF NORTH FLORIDA LLC | EXPIRED | 2010-01-15 | 2015-12-31 | No data | 3 CYPRESS BRANCH WAY, SUITE 107, PALM COAST, FL, 32164 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-28 | 124 INLET DR, SAINT AUGUSTINE, FL 32080 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-28 | 124 INLET DR, SAINT AUGUSTINE, FL 32080 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-03 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-01-03 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-03-22 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
