| Entity Name: | LITTLE SMILES DENTAL OF PALM BEACH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 17 Oct 2014 (10 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L14000162319 |
| FEI/EIN Number | 47-2106296 |
| Address: | 400 EXECUTIVE CENTER DRIVE, SUITE #103, WEST PALM BEACH, FL, 33401 |
| Mail Address: | 400 EXECUTIVE CENTER DRIVE, SUITE #103, WEST PALM BEACH, FL, 33401 |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629473913 | 2014-10-29 | 2014-10-29 | 400 EXECUTIVE CENTER DR, STE 103, WEST PALM BEACH, FL, 334012917, US | 400 EXECUTIVE CENTER DR, STE 103, WEST PALM BEACH, FL, 334012917, US | |||||||||||||||||||||||||
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| Phone | +1 561-736-8755 |
| Fax | 5617363996 |
Authorized person
| Name | MR. BAYARDO CARLOS CORTES |
| Role | OWNER/PROVIDER |
| Phone | 5617368755 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN15894 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JIRON & COMPANY, CPA, PA | Agent | 5200 SW 8TH STREET, CORAL GABLES, FL, 33134 |
| Name | Role | Address |
|---|---|---|
| SPENCER CRAIG | Manager | 625 SE 2ND AVENUE, STE D, BOYNTON BEACH, FL, 33435 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| LC AMENDMENT | 2014-12-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-02-22 |
| ANNUAL REPORT | 2015-04-10 |
| LC Amendment | 2014-12-11 |
| Florida Limited Liability | 2014-10-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
