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BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC - Florida Company Profile

Company Details

Entity Name:	BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC
Jurisdiction:	FLORIDA
Filing Type:	Florida Limited Liability Company BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC 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. In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status:	Active The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.
Date Filed:	06 Jun 2011 (14 years ago)
Last Event:	LC DISSOCIATION MEM
Event Date Filed:	23 Aug 2016 (9 years ago)
Document Number:	L11000065863
FEI/EIN Number	45-2529289 Federal Employer Identification (FEI) Number assigned by the IRS.
Address:	4308 ALTON ROAD, SUITE 850, MIAMI BEACH, FL 33140
Mail Address:	4308 ALTON ROAD, SUITE 850, MIAMI BEACH, FL 33140
ZIP code:	33140
County:	Miami-Dade
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1467737684

2011-10-19

2011-10-19

4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558, US

4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558, US

Contacts

Phone	+1 305-538-4556
Fax	3055382019

Authorized person

Name	DR. JEFFERY D. BLUM
Role	OWNER
Phone	3055384556

Taxonomy

Taxonomy Code	1223P0300X - Periodontist
License Number	L11000065863
State	FL
Is Primary	No
Taxonomy Code	1223S0112X - Oral and Maxillofacial Surgery (Dentist)
License Number	L11000065863
State	FL
Is Primary	Yes

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

NICO PROFIT SHARING PLAN

2023

452529289

2024-07-01

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

15

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

NICO PROFIT SHARING PLAN

2022

452529289

2023-09-07

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

15

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

NICO PROFIT SHARING PLAN

2021

452529289

2022-09-15

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

15

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

NICO PROFIT SHARING PLAN

2020

452529289

2021-06-30

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

13

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

NICO PROFIT SHARING PLAN

2019

452529289

2020-05-12

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

14

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

NICO PROFIT SHARING PLAN

2018

452529289

2019-07-24

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

10

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

NICO PROFIT SHARING PLAN

2017

452529289

2018-05-15

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

8

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON RD STE 850, MIAMI BEACH, FL, 331404558

BLUM-NICO PROFIT SHARING PLAN

2016

452529289

2017-07-25

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

13

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON ROAD, STE 850, MIAMI BEACH, FL, 33140

BLUM-NICO PROFIT SHARING PLAN

2015

452529289

2016-08-24

BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC

12

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1991-01-01
Business code	621210
Sponsor’s telephone number	3055384556
Plan sponsor’s address	4308 ALTON ROAD, SUITE 850, MIAMI BEACH, FL, 33140

Key Officers & Management

Name	Role	Address
Marquez, Antonio	Agent	4308 ALTON ROAD, SUITE 850, MIAMI BEACH, FL 33140
Nicolaievsky, Eduardo, DDS	Manager	4308 ALTON ROAD, SUITE 850 MIAMI BEACH, FL 33140

Events

Event Type	Filed Date	Value	Description
LC DISSOCIATION MEM	2016-08-23	-	-
REGISTERED AGENT NAME CHANGED	2013-01-15	Marquez, Antonio	-
REGISTERED AGENT ADDRESS CHANGED	2013-01-15	4308 ALTON ROAD, SUITE 850, MIAMI BEACH, FL 33140	-

Documents

Name	Date
ANNUAL REPORT	2025-02-06
ANNUAL REPORT	2024-01-18
ANNUAL REPORT	2023-01-26
ANNUAL REPORT	2022-01-24
ANNUAL REPORT	2021-01-22
ANNUAL REPORT	2020-01-15
ANNUAL REPORT	2019-03-14
ANNUAL REPORT	2018-01-29
ANNUAL REPORT	2017-01-19
CORLCDSMEM	2016-08-23
ANNUAL REPORT	2016-01-21
ANNUAL REPORT	2015-01-14
ANNUAL REPORT	2014-01-09
ANNUAL REPORT	2013-01-15
ANNUAL REPORT	2012-01-13
Florida Limited Liability	2011-06-06

Paycheck Protection Program

Loan Number

Loan Funded Date

SBA Origination Office Code

Loan Delivery Method

Borrower Street Address

4709147007

2020-04-04

0455

PPP

4380 Alton Road #14, MIAMI BEACH, FL, 33140-2800

Loan Status Date	2021-06-17
Loan Status	Paid in Full
Loan Maturity in Months	24
SBA Guaranty Percentage	100
Loan Approval Amount (at origination)	301300
Loan Approval Amount (current)	301300
Undisbursed Amount	0
Franchise Name	-
Lender Location ID	17124
Servicing Lender Name	City National Bank of Florida
Servicing Lender Address	100 SE 2nd St, MIAMI, FL, 33131
Rural or Urban Indicator	U
Hubzone	N
LMI	N
Business Age Description	Existing or more than 2 years old
Project Address	MIAMI BEACH, MIAMI-DADE, FL, 33140-2800
Project Congressional District	FL-24
Number of Employees	14
NAICS code	621210
Borrower Race	Unanswered
Borrower Ethnicity	Unknown/NotStated
Business Type	Limited Liability Company(LLC)
Originating Lender ID	17124
Originating Lender Name	City National Bank of Florida
Originating Lender Address	MIAMI, FL
Gender	Male Owned
Veteran	Unanswered
Forgiveness Amount	304519.37
Forgiveness Paid Date	2021-05-11

Date of last update: 23 Feb 2025

Sources: Florida Department of State