| Entity Name: | CARLSON DENTAL GROUP PROVIDERS, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
CARLSON DENTAL GROUP PROVIDERS, LLC. is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 02 Sep 2010 (15 years ago) |
| Date of dissolution: | 22 Sep 2023 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (2 years ago) |
| Document Number: | L10000092557 |
| FEI/EIN Number |
273385367
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL, 32258, US |
| Mail Address: | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL, 32258, US |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265867691 | 2013-09-04 | 2013-09-04 | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL, 322585212, US | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL, 322585212, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 904-262-8409 |
| Fax | 9042624012 |
Authorized person
| Name | DR. RICHARD DEAN CARLSON |
| Role | OWNER |
| Phone | 9042628409 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN19024 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN20275 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | DN18532 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| GLAZIER, GLAZIER & DIETRICH, P.A. | Agent | - |
| CARLSON RICHARD D | Manager | 13241 BARTRAM PARK BLVD, JACKSONVILLE, FL, 32258 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-26 | 8833 PERIMETER PARK BLVD., SUITE 1002, JACKSONVILLE, FL 32216 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-28 | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258 | - |
| CHANGE OF MAILING ADDRESS | 2016-04-28 | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258 | - |
| LC NAME CHANGE | 2011-01-26 | CARLSON DENTAL GROUP PROVIDERS, LLC. | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-18 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-30 |
| ANNUAL REPORT | 2014-01-20 |
| ANNUAL REPORT | 2013-04-29 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
