| Entity Name: | PEDIATRIC & FAMILY DENTAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Aug 2014 (10 years ago) |
| Document Number: | L14000130516 |
| FEI/EIN Number | 47-1641936 |
| Mail Address: | 12601 Narcoossee Road, Orlando, FL, 32832, US |
| Address: | 6161 Winegard Road, Orlando, FL, 32809, US |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710388269 | 2014-09-15 | 2015-07-28 | PO BOX 590710, ORLANDO, FL, 328590710, US | 6161 WINEGARD RD, ORLANDO, FL, 328094977, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-749-0113 |
| Fax | 4077865878 |
Authorized person
| Name | MS. JOCELYN ESPEJO |
| Role | PRACTICE MANAGER |
| Phone | 4077377767 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN19618 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN20790 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN18209 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN17111 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Hernandez Linnette DMD | Agent | 12601 Narcoossee Road, Orlando, FL, 32832 |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ LINNETTE Dr. | Authorized Member | 12601 Narcoossee Road, Orlando, FL, 32832 |
| AINA OLUBISI Dr. | Authorized Member | 12601 Narcoossee Road, Orlando, FL, 32832 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-01-12 | 6161 Winegard Road, Orlando, FL 32809 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-12 | 12601 Narcoossee Road, Suite 203, Orlando, FL 32832 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-01-28 | 6161 Winegard Road, Orlando, FL 32809 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-20 | Hernandez, Linnette, DMD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-03-26 |
| ANNUAL REPORT | 2020-01-12 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-04-16 |
| ANNUAL REPORT | 2015-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
