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MID BAY DENTAL, PLLC

Company Details

Entity Name: MID BAY DENTAL, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 31 Dec 2014 (10 years ago)
Document Number: L14000196989
FEI/EIN Number N/A
Address: 4579 FLORIDA HWY 20 E, Suite 210, NICEVILLE, FL 32578
Mail Address: 4579 FLORIDA HWY 20 E, Suite 210, NICEVILLE, FL 32578
ZIP code: 32578
County: Okaloosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528427739 2016-02-16 2022-02-04 4579 E HIGHWAY 20 STE 210, NICEVILLE, FL, 325789810, US 4579 E HIGHWAY 20 STE 210, NICEVILLE, FL, 325789810, US

Contacts

Phone +1 850-897-4200

Authorized person

Name FAITH GASKINS
Role DIRECTOR OF CREDENTIALING
Phone 9728693789

Taxonomy

Taxonomy Code 1223G0001X - General Practice Dentistry
License Number DN20656
State FL
Is Primary Yes

Agent

Name Role Address
Chase, Justine, Dr. Agent 4579 FLORIDA HWY 20 E, Suite 210, NICEVILLE, FL 32578

Manager

Name Role Address
CHASE, JUSTINE Manager 4579 FLORIDA HWY 20 E, Suite 210 NICEVILLE, FL 32578

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2020-02-09 4579 FLORIDA HWY 20 E, Suite 210, NICEVILLE, FL 32578 No data
CHANGE OF MAILING ADDRESS 2020-02-09 4579 FLORIDA HWY 20 E, Suite 210, NICEVILLE, FL 32578 No data
REGISTERED AGENT NAME CHANGED 2020-02-09 Chase, Justine, Dr. No data
REGISTERED AGENT ADDRESS CHANGED 2020-02-09 4579 FLORIDA HWY 20 E, Suite 210, NICEVILLE, FL 32578 No data

Documents

Name Date
ANNUAL REPORT 2025-02-06
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-02-03
ANNUAL REPORT 2022-03-02
ANNUAL REPORT 2021-03-15
ANNUAL REPORT 2020-02-09
ANNUAL REPORT 2019-03-19
ANNUAL REPORT 2018-03-12
ANNUAL REPORT 2017-03-24
ANNUAL REPORT 2016-04-26

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2664667300 2020-04-29 0491 PPP 4579 HIGHWAY 20 E, SUITE 210, NICEVILLE, FL, 32578-9810
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) 93336
Loan Approval Amount (current) 93336
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39334
Servicing Lender Name Trustmark National Bank
Servicing Lender Address 248 E Capitol St, JACKSON, MS, 39201-2503
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address NICEVILLE, OKALOOSA, FL, 32578-9810
Project Congressional District FL-01
Number of Employees 8
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Sole Proprietorship
Originating Lender ID 39334
Originating Lender Name Trustmark National Bank
Originating Lender Address JACKSON, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 93976.39
Forgiveness Paid Date 2021-01-08
6073008500 2021-03-02 0491 PPS 4579 E Highway 20 Ste 210, Niceville, FL, 32578-9810
Loan Status Date 2022-02-19
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 84951
Loan Approval Amount (current) 84951
Undisbursed Amount 0
Franchise Name -
Lender Location ID 188567
Servicing Lender Name Loan Source Incorporated
Servicing Lender Address 353 East 83rd Street Suite 3H, NEW YORK, NY, 10028
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Niceville, OKALOOSA, FL, 32578-9810
Project Congressional District FL-01
Number of Employees 9
NAICS code 621210
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Not Hispanic or Latino
Business Type Sole Proprietorship
Originating Lender ID 39334
Originating Lender Name Trustmark National Bank
Originating Lender Address JACKSON, MS
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 85260.55
Forgiveness Paid Date 2021-08-04

Date of last update: 20 Feb 2025

Sources: Florida Department of State