| Entity Name: | CRANIOFACIAL, RECONSTRUCTIVE AND COSMETIC SURGERY ASSOCIATES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Aug 2013 (12 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L13000109270 |
| FEI/EIN Number | 463379429 |
| Address: | 1949 Isla De Palma Circle, Naples, FL, 34119, US |
| Mail Address: | 1949 Isla De Palma Circle, Naples, FL, 34119, US |
| ZIP code: | 34119 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447673173 | 2014-01-31 | 2015-01-24 | 1949 ISLA DE PALMA CIR, NAPLES, FL, 341193403, US | 6705 SW 57TH AVE STE 510, SOUTH MIAMI, FL, 331433644, US | |||||||||||||||||||||||||||||||
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| Phone | +1 786-471-4299 |
Authorized person
| Name | DR. STONE R THAYER |
| Role | PRESIDENT |
| Phone | 7864714299 |
Taxonomy
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| License Number | ME114524 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME114524 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THAYER STONE | Agent | 1949 ISLA DE PALMA CIR, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| THAYER STONE | Managing Member | 1949 ISLA DE PALMA CIR, NAPLES, FL, 34119 |
| RANGARAJAN CHITRA | Managing Member | 1949 ISLA DE PALMA CIR, NAPLES, FL, 34119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-29 | 1949 Isla De Palma Circle, Naples, FL 34119 | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-24 | 1949 Isla De Palma Circle, Naples, FL 34119 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-02-19 |
| ANNUAL REPORT | 2020-03-29 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-03-25 |
| ANNUAL REPORT | 2017-04-30 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-02-21 |
| ANNUAL REPORT | 2014-04-24 |
| Florida Limited Liability | 2013-08-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
