| Entity Name: | KIDZ CHOICE PEDIATRIC DENTISTRY OF CENTRAL FLORIDA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Jul 2013 (12 years ago) |
| Document Number: | L13000097315 |
| FEI/EIN Number | 46-3156228 |
| Address: | 2515 Caribbean Court, ORLANDO, FL 32805 |
| Mail Address: | 2515 Caribbean Court, ORLANDO, FL 32805 |
| ZIP code: | 32805 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194157222 | 2013-07-31 | 2013-07-31 | 508 N MILLS AVE, SUITE B, ORLANDO, FL, 328035353, US | 508 N MILLS AVE, SUITE B, ORLANDO, FL, 328035353, US | |||||||||||||||||||||||||
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| Phone | +1 407-422-2617 |
| Fax | 4078416843 |
Authorized person
| Name | JERESIA CHOICE |
| Role | OWNER |
| Phone | 4074222617 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | DN18945 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008810400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHOICE, JERESIA, DDS | Agent | 2515 Caribbean Court, ORLANDO, FL 32805 |
| Name | Role | Address |
|---|---|---|
| CHOICE, JERESIA, DDS | Manager | 2515 Caribbean Court, ORLANDO, FL 32805 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-01 | 2515 Caribbean Court, ORLANDO, FL 32805 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-11 | 2515 Caribbean Court, ORLANDO, FL 32805 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-11 | 2515 Caribbean Court, ORLANDO, FL 32805 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000182851 | TERMINATED | 1000000883615 | ORANGE | 2021-04-08 | 2031-04-21 | $ 1,325.43 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ORLANDO SERVICE CENTER, 400 W ROBINSON ST STE N302, ORLANDO FL328011759 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-06-08 |
| ANNUAL REPORT | 2020-06-22 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-02-05 |
| ANNUAL REPORT | 2015-02-23 |
Date of last update: 21 Feb 2025
Sources: Florida Department of State
