| Entity Name: | CHURCHILL PEDIATRIC DENTISTRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
CHURCHILL PEDIATRIC DENTISTRY, LLC 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. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 08 Oct 2013 (12 years ago) |
| Date of dissolution: | 28 Sep 2018 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (7 years ago) |
| Document Number: | L13000141891 |
| FEI/EIN Number |
46-3826187
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1397 W Lakeshore Dr, Clermont, FL, 34711, US |
| Mail Address: | 1397 W Lakeshore Dr, Clermont, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487081352 | 2013-10-08 | 2013-10-08 | 1371 SW 43RD PL, OCALA, FL, 344717501, US | 1371 SW 43RD PL, OCALA, FL, 344717501, US | |||||||||||||||||||||||
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| Phone | +1 352-274-9731 |
Authorized person
| Name | DR. REBECCA J TARVER |
| Role | OWNER |
| Phone | 3522749731 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN19038 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002880200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TARVER REBECCA J | Manager | 1397 W Lakeshore Dr, Clermont, FL, 34711 |
| TARVER REBECCA J | Agent | 1397 W Lakeshore Dr, Clermont, FL, 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-28 | 1397 W Lakeshore Dr, Clermont, FL 34711 | - |
| CHANGE OF MAILING ADDRESS | 2016-04-28 | 1397 W Lakeshore Dr, Clermont, FL 34711 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-28 | 1397 W Lakeshore Dr, Clermont, FL 34711 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-03-21 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-23 |
| ANNUAL REPORT | 2014-04-15 |
| Florida Limited Liability | 2013-10-08 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
