| Entity Name: | MAIN STREET CHILDREN'S DENTISTRY OF MIAMI LAKES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Aug 2014 (10 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 25 Apr 2024 (9 months ago) |
| Document Number: | L14000122859 |
| FEI/EIN Number | 47-1515809 |
| Mail Address: | 6240 LAKE OSPREY DRIVE, SARASOTA, FL 34240 |
| Address: | 15501 NW 67TH AVENUE, SUITE 201, MIAMI LAKES, FL 33014 |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043611858 | 2014-09-11 | 2015-06-23 | 15501 NW 67TH AVE STE 201, MIAMI LAKES, FL, 330142108, US | 15501 NW 67TH AVE STE 201, MIAMI LAKES, FL, 330142108, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 786-577-4968 |
Authorized person
| Name | STEPHANIE GOMEZ |
| Role | PROVIDER RELATIONS |
| Phone | 3052742499 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| GALLO, DONALD | DIRECTOR | 6240 LAKE OSPREY DRIVE, SARASOTA, FL 34240 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000012105 | DENTAL ASSOCIATES OF MIAMI LAKES | ACTIVE | 2015-02-03 | 2025-12-31 | No data | 6240 LAKE OSPREY DR, SUITE 201, SARASOTA, FL, 34240 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2024-04-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-25 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-25 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| LC NAME CHANGE | 2014-08-29 | MAIN STREET CHILDREN'S DENTISTRY OF MIAMI LAKES, PLLC | No data |
| Name | Date |
|---|---|
| CORLCRACHG | 2024-04-25 |
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-04-03 |
| ANNUAL REPORT | 2016-03-31 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
