| Entity Name: | SOUTH TAMPA DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Oct 2010 (14 years ago) |
| Document Number: | L10000108613 |
| FEI/EIN Number | 273710762 |
| Address: | 3112 W. KENNEDY BLVD, TAMPA, FL, 33609, US |
| Mail Address: | 3112 W. KENNEDY BLVD, TAMPA, FL, 33609, US |
| ZIP code: | 33609 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316242787 | 2011-01-17 | 2011-01-17 | 3112 W KENNEDY BLVD, TAMPA, FL, 336093021, US | 3112 W KENNEDY BLVD, TAMPA, FL, 336093021, US | |||||||||||||||||
|
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| Phone | +1 813-874-5869 |
Authorized person
| Name | MRS. JENNY LEON |
| Role | RECEPTIONIST |
| Phone | 8138745869 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN0010475 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DIEZ RANDALL A | Agent | 3112 W. KENNEDY BLVD, TAMPA, FL, 33609 |
| Name | Role |
|---|---|
| RANDALL A. DIEZ, D.M.D., P.A. | Managing Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
