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  5. PEDIATRIC DENTAL GROUP OF TAMPA, LLC

PEDIATRIC DENTAL GROUP OF TAMPA, LLC

Company Details

Entity Name: PEDIATRIC DENTAL GROUP OF TAMPA, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 11 Jun 2014 (11 years ago)
Last Event: LC DISSOCIATION MEM
Event Date Filed: 22 Jul 2016 (9 years ago)
Document Number: L14000093954
FEI/EIN Number 81-1815802
Address: 11012 N. DALE MABRY HWY., SUITE 302, TAMPA, FL 33618
Mail Address: 11012 N. DALE MABRY HWY., SUITE 302, TAMPA, FL 33618
ZIP code: 33618
County: Hillsborough
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2023 811815802 2024-05-12 PEDIATRIC DENTAL GROUP OF TAMPA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2024-05-12
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2022 811815802 2023-07-18 PEDIATRIC DENTAL GROUP OF TAMPA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2023-07-18
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2021 811815802 2022-09-19 PEDIATRIC DENTAL GROUP OF TAMPA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2022-09-19
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2020 811815802 2021-05-21 PEDIATRIC DENTAL GROUP OF TAMPA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2021-05-21
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2019 811815802 2020-05-09 PEDIATRIC DENTAL GROUP OF TAMPA 6
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2020-05-09
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2019 811815802 2020-06-17 PEDIATRIC DENTAL GROUP OF TAMPA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2020-06-17
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2018 811815802 2019-02-27 PEDIATRIC DENTAL GROUP OF TAMPA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2019-02-27
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL GROUP OF TAMPA 401(K) PLAN 2017 811815802 2018-04-17 PEDIATRIC DENTAL GROUP OF TAMPA 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8139611414
Plan sponsor’s address 11012 N DALE MABRY HWY., SUITE 302, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2018-04-17
Name of individual signing DUSTIN DEDOMENICO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DEDOMENICO, DUSTIN A Agent 11012 N. DALE MABRY HWY., SUITE 302, TAMPA, FL 33618

vp

Name Role Address
DeDomenico, Dustin Andrew vp 11012 N. DALE MABRY HWY., SUITE 302 TAMPA, FL 33618

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000038910 DEDOMENICO PEDIATRIC DENTISTRY ACTIVE 2016-04-19 2026-12-31 No data 11012 NORTH DALE MABRY HIGHWAY STE 302, TAMPA, FL, 33618

Events

Event Type Filed Date Value Description
LC STMNT OF RA/RO CHG 2016-07-22 No data No data
LC DISSOCIATION MEM 2016-07-22 No data No data
REGISTERED AGENT NAME CHANGED 2016-07-22 DEDOMENICO, DUSTIN A No data

Documents

Name Date
ANNUAL REPORT 2025-01-30
ANNUAL REPORT 2024-01-13
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-01-23
ANNUAL REPORT 2021-01-30
ANNUAL REPORT 2020-01-11
ANNUAL REPORT 2019-02-07
ANNUAL REPORT 2018-03-01
ANNUAL REPORT 2017-02-15
CORLCDSMEM 2016-07-22

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3076987202 2020-04-16 0455 PPP 11012 N Dale Mabry Hwy STE #302, Tampa, FL, 33618
Loan Status Date 2021-02-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 56700
Loan Approval Amount (current) 56700
Undisbursed Amount 0
Franchise Name -
Lender Location ID 225134
Servicing Lender Name Truist Bank
Servicing Lender Address 214 N Tryon St, CHARLOTTE, NC, 28202-1078
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Tampa, HILLSBOROUGH, FL, 33618-1000
Project Congressional District FL-15
Number of Employees 10
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 225134
Originating Lender Name Truist Bank
Originating Lender Address CHARLOTTE, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 57090.6
Forgiveness Paid Date 2021-01-08
5206618506 2021-02-27 0455 PPS 11012 N Dale Mabry Hwy Ste 302, Tampa, FL, 33618-3821
Loan Status Date 2021-10-21
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 55250
Loan Approval Amount (current) 55250
Undisbursed Amount 0
Franchise Name -
Lender Location ID 225134
Servicing Lender Name Truist Bank
Servicing Lender Address 214 N Tryon St, CHARLOTTE, NC, 28202-1078
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Tampa, HILLSBOROUGH, FL, 33618-3821
Project Congressional District FL-15
Number of Employees 10
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 225134
Originating Lender Name Truist Bank
Originating Lender Address CHARLOTTE, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 55513.97
Forgiveness Paid Date 2021-08-31

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Date of last update: 20 Feb 2025

Sources: Florida Department of State

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