| Entity Name: | CARLSON DENTAL GROUP PROVIDERS, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 02 Sep 2010 (14 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L10000092557 |
| FEI/EIN Number | 273385367 |
| 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 | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| 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 |
|---|---|
| GLAZIER, GLAZIER & DIETRICH, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| 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 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-26 | 8833 PERIMETER PARK BLVD., SUITE 1002, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-28 | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258 | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-28 | 13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258 | No data |
| LC NAME CHANGE | 2011-01-26 | CARLSON DENTAL GROUP PROVIDERS, LLC. | No data |
| 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 Feb 2025
Sources: Florida Department of State
