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  5. SALT RUN FAMILY DENTISTRY, LLC

SALT RUN FAMILY DENTISTRY, LLC - Florida Company Profile

Company Details

Entity Name: SALT RUN FAMILY DENTISTRY, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

SALT RUN FAMILY DENTISTRY, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 01 Jun 2015 (10 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 10 Jan 2017 (8 years ago)
Document Number: L15000095692
FEI/EIN Number 47-4234142

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 700 ANASTASIA BLVD, SAINT AUGUSTINE, FL, 32080
Mail Address: 700 ANASTASIA BLVD, SAINT AUGUSTINE, FL, 32080, US
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1720463714 2015-07-20 2015-07-20 700 ANASTASIA BLVD, SAINT AUGUSTINE, FL, 320804616, US 700 ANASTASIA BLVD, SAINT AUGUSTINE, FL, 320804616, US

Contacts
Phone +1 904-824-3540
Fax 9048243541

Authorized person
Name DR. VINCENT MICHAEL LETH II
Role OWNER
Phone 9048243540

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number DN18649
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN AND TRUST 2023 474234142 2024-08-07 SALT RUN FAMILY DENTISTRY 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 541990
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2024-08-07
Name of individual signing MICKEY LETH
Valid signature Filed with authorized/valid electronic signature
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN AND TRUST 2022 474234142 2023-07-05 SALT RUN FAMILY DENTISTRY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 541990
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2023-07-05
Name of individual signing MICKEY LETH
Valid signature Filed with authorized/valid electronic signature
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN AND TRUST 2021 474234142 2022-07-26 SALT RUN FAMILY DENTISTRY 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 541990
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2022-07-26
Name of individual signing MICKEY LETH
Valid signature Filed with authorized/valid electronic signature
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN AND TRUST 2020 474234142 2022-10-10 SALT RUN FAMILY DENTISTRY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 541990
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing MICKEY LETH
Valid signature Filed with authorized/valid electronic signature
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN AND TRUST 2020 474234142 2021-10-12 SALT RUN FAMILY DENTISTRY 11
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 541990
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD, ST AUGUSTINE, FL, 320804616

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing VINCENT LETH
Valid signature Filed with authorized/valid electronic signature
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN 2019 474234142 2020-07-31 SALT RUN FAMILY DENTISTRY 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN 2018 474234142 2019-06-13 SALT RUN FAMILY DENTISTRY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN 2017 474234142 2018-07-25 SALT RUN FAMILY DENTISTRY 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080
SALT RUN FAMILY DENTISTRY 401(K) PROFIT SHARING PLAN 2016 474234142 2017-09-12 SALT RUN FAMILY DENTISTRY 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9048243540
Plan sponsor’s address 700 ANASTASIA BLVD., ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2017-09-12
Name of individual signing DR. VINCENT LETH
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
LETH VINCENT MJR Authorized Member 1684 CASTILE ST, SAINT AUGUSTINE, FL, 32080
LETH LAUREN P Authorized Member 1684 CASTILE ST, SAINT AUGUSTINE, FL, 32080
LETH VINCENT MJR Agent 1684 CASTILE ST, SAINT AUGUSTINE, FL, 32080

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2018-01-04 700 ANASTASIA BLVD, SAINT AUGUSTINE, FL 32080 -
REINSTATEMENT 2017-01-10 - -
REGISTERED AGENT NAME CHANGED 2017-01-10 LETH, VINCENT M, JR -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 - -

Documents

Name Date
ANNUAL REPORT 2024-03-01
ANNUAL REPORT 2023-02-02
ANNUAL REPORT 2022-03-07
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-01-23
ANNUAL REPORT 2018-01-04
REINSTATEMENT 2017-01-10
Florida Limited Liability 2015-06-01

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4468157705 2020-05-01 0491 PPP 700 ANASTASIA BLVD, SAINT AUGUSTINE, FL, 32080
Loan Status Date 2021-08-12
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 126544
Loan Approval Amount (current) 126544
Undisbursed Amount 0
Franchise Name -
Lender Location ID 12096
Servicing Lender Name Wells Fargo Bank, National Association
Servicing Lender Address 101 N Philips Ave, SIOUX FALLS, SD, 57104-6738
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address SAINT AUGUSTINE, SAINT JOHNS, FL, 32080-0001
Project Congressional District FL-05
Number of Employees 14
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 12096
Originating Lender Name Wells Fargo Bank, National Association
Originating Lender Address SIOUX FALLS, SD
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 128003.59
Forgiveness Paid Date 2021-07-06
3690128503 2021-02-24 0491 PPS 700 Anastasia Blvd, Saint Augustine, FL, 32080-4616
Loan Status Date 2022-02-16
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 120545
Loan Approval Amount (current) 120545
Undisbursed Amount 0
Franchise Name -
Lender Location ID 12096
Servicing Lender Name Wells Fargo Bank, National Association
Servicing Lender Address 101 N Philips Ave, SIOUX FALLS, SD, 57104-6738
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Saint Augustine, SAINT JOHNS, FL, 32080-4616
Project Congressional District FL-05
Number of Employees 15
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 12096
Originating Lender Name Wells Fargo Bank, National Association
Originating Lender Address SIOUX FALLS, SD
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 121644.77
Forgiveness Paid Date 2022-01-25

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LETH LAUREN P

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Companies related by address

700 ANASTASIA BLVD, SAINT AUGUSTINE, FL, 32080

BERT A. TAVARY, P.A.

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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