| Entity Name: | BRANDON GREENWALT DMD PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jun 2014 (11 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 12 Jun 2017 (8 years ago) |
| Document Number: | L14000102928 |
| FEI/EIN Number | 47-1243578 |
| Address: | 12443 San Jose Blvd, Suite 101, Jacksonville, FL, 32223, US |
| Mail Address: | 328 West Kari Court, Jacksonville, FL, 32259, US |
| ZIP code: | 32223 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154770733 | 2016-06-06 | 2016-06-06 | 328 W KARI CT, JACKSONVILLE, FL, 322593320, US | 12443 SAN JOSE BLVD STE 101, JACKSONVILLE, FL, 322238647, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 317-408-5764 |
| Phone | +1 904-262-6188 |
Authorized person
| Name | DR. BRANDON LEE GREENWALT |
| Role | PRESIDENT |
| Phone | 3174085764 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN19737 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Callahan Taylor M | Agent | 12443 San Jose Blvd, Jacksonville, FL, 32223 |
| Name | Role | Address |
|---|---|---|
| GREENWALT BRANDON | Auth | 328 West Kari Court, Jacksonville, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| Callahan Taylor M | Authorized Member | 328 West Kari Court, Jacksonville, FL, 32259 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-01-13 | Callahan, Taylor M | No data |
| LC AMENDMENT | 2017-06-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-08-10 | 12443 San Jose Blvd, Suite 101, Jacksonville, FL 32223 | No data |
| CHANGE OF MAILING ADDRESS | 2016-08-10 | 12443 San Jose Blvd, Suite 101, Jacksonville, FL 32223 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-08-10 | 12443 San Jose Blvd, Suite 101, Jacksonville, FL 32223 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-03-07 |
| LC Amendment | 2017-06-12 |
| ANNUAL REPORT | 2017-01-19 |
| AMENDED ANNUAL REPORT | 2016-08-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
