| Entity Name: | EVERGLADES PEDIATRIC DENTISTRY II, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Mar 2014 (11 years ago) |
| Document Number: | L14000047001 |
| FEI/EIN Number | 47-4364117 |
| Address: | 5606 US Hwy 27 N, Sebring, FL, 33870, US |
| Mail Address: | 5606 US Hwy 27 N, Sebring, FL, 33870, US |
| ZIP code: | 33870 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588029300 | 2015-12-21 | 2015-12-21 | 5606 US HIGHWAY 27 N, SEBRING, FL, 338701211, US | 5606 US HIGHWAY 27 N, SEBRING, FL, 338701211, US | |||||||||||||||||||||||||
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| Phone | +1 863-382-0340 |
| Fax | 8633577342 |
Authorized person
| Name | DR. MELISSA DANIELLE KINDELL |
| Role | OWNER/DENTIST |
| Phone | 8633820340 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN16660 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1223P0221X |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KINDELL MELISSA D | Agent | 2029 HWY 441 N, OKEECHOBEE, FL, 34972 |
| Name | Role | Address |
|---|---|---|
| KINDELL MELISSA D | Manager | 2029 HWY 441 N, OKEECHOBEE, FL, 34972 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000065804 | EVERGLADES PEDIATRIC DENTISTRY | EXPIRED | 2015-06-24 | 2020-12-31 | No data | 2029 HWY 441 NORTH, OKEECHOBEE, FL, 34972 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-11 | 5606 US Hwy 27 N, Sebring, FL 33870 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-11 | 5606 US Hwy 27 N, Sebring, FL 33870 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-07-14 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-06-08 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
