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  5. TARPON SHORES DENTAL, LLC

TARPON SHORES DENTAL, LLC

Company Details

Entity Name: TARPON SHORES DENTAL, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 07 Nov 2012 (12 years ago)
Date of dissolution: 10 May 2022 (3 years ago)
Last Event: LC VOLUNTARY DISSOLUTION
Event Date Filed: 10 May 2022 (3 years ago)
Document Number: L12000141254
FEI/EIN Number 46-1373259
Address: 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285, US
Mail Address: 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285, US
ZIP code: 34285
County: Sarasota
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1447597802 2013-01-05 2016-11-22 1314 E VENICE AVE, SUITE F, VENICE, FL, 342857160, US 544 JOHN RINGLING BLVD, SARASOTA, FL, 342361430, US

Contacts
Phone +1 941-488-7910
Phone +1 941-388-4114

Authorized person
Name DR. CHANDEEV ROMESH WEERASOORIYA
Role MANAGER
Phone 9414749548

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
Is Primary Yes

Other Provider Identifiers
Issuer MEDICARE CCN
Number 511613837863
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2019 461373259 2020-12-22 TARPON SHORES DENTAL, LLC 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2020-12-22
Name of individual signing R SCOTT THOMPSON D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-12-22
Name of individual signing R SCOTT THOMPSON D.D.S.
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2019 461373259 2020-04-07 TARPON SHORES DENTAL, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2020-04-07
Name of individual signing ROBERT THOMPSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-07
Name of individual signing ROBERT THOMPSON
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2018 461373259 2019-05-06 TARPON SHORES DENTAL, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2019-05-02
Name of individual signing ROBERT THOMPSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-02
Name of individual signing ROBERT THOMPSON
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2017 461373259 2018-05-01 TARPON SHORES DENTAL, LLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2018-04-27
Name of individual signing ROBERT THOMPSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-04-27
Name of individual signing ROBERT THOMPSON
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2016 461373259 2017-06-14 TARPON SHORES DENTAL, LLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2017-06-13
Name of individual signing ROBERT THOMPSON DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-13
Name of individual signing ROBERT THOMPSON DDS
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2015 461373259 2016-03-08 TARPON SHORES DENTAL, LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2016-03-07
Name of individual signing R. SCOTT THOMPSON DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-03-07
Name of individual signing R. SCOTT THOMPSON DDS
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2014 461373259 2015-04-14 TARPON SHORES DENTAL, LLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2015-04-14
Name of individual signing R. SCOTT THOMPSON, D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-14
Name of individual signing R. SCOTT THOMPSON, D.D.S.
Valid signature Filed with authorized/valid electronic signature
TARPON SHORES DENTAL, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2013 461373259 2014-09-04 TARPON SHORES DENTAL, LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 9414887910
Plan sponsor’s address 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 342857160

Signature of
Role Plan administrator
Date 2014-09-03
Name of individual signing R. SCOTT THOMPSON, D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-03
Name of individual signing R. SCOTT THOMPSON, D.D.S.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CHESTNUT BUSINESS SERVICES, LLC Agent

Manager

Name Role Address
WEERASOORIYA C. ROMESH D Manager 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285
THOMPSON R. SCOTT D Manager 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285
WEERASOORIYA SHANAKA L Manager 1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2024-12-03 311 PARK PLACE BOULEVARD, SUITE 300, CLEARWATER, FL 33759 No data
LC VOLUNTARY DISSOLUTION 2022-05-10 No data No data
REGISTERED AGENT NAME CHANGED 2016-02-29 Chestnut Business Services, LLC No data
LC NAME CHANGE 2013-10-17 TARPON SHORES DENTAL, LLC No data

Documents

Name Date
LC Voluntary Dissolution 2022-05-10
ANNUAL REPORT 2022-04-11
ANNUAL REPORT 2021-04-30
ANNUAL REPORT 2020-03-20
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-01-10
ANNUAL REPORT 2017-01-16
ANNUAL REPORT 2016-02-29
ANNUAL REPORT 2015-01-29
ANNUAL REPORT 2014-03-05

Related by officers

WEERASOORIYA SHANAKA L

WEERASOORIYA & WEERASOORIYA, D.M.D., P.A.

Related by address

1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285, US

SHORE DENTAL, LLC

1314 EAST VENICE AVENUE, SUITE F, VENICE, FL, 34285, US

SHORE DENTAL, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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