| Entity Name: | MARYAM BANGASH DDS HOLDINGS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 24 Jul 2015 (10 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L15000125893 |
| FEI/EIN Number | 474687758 |
| Address: | 1291 Peregrine Way, Weston, FL, 33327, US |
| Mail Address: | 1291 Peregrine Way, Weston, FL, 33327, US |
| ZIP code: | 33327 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255707774 | 2015-08-19 | 2015-08-19 | 24185 US HIGHWAY 27, LAKE WALES, FL, 338597819, US | 24185 US HIGHWAY 27, LAKE WALES, FL, 338597819, US | |||||||||||||||||||
|
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| Phone | +1 863-676-6200 |
| Fax | 8636792561 |
Authorized person
| Name | KIM VAN CAMP |
| Role | PROVIDER RELATIONS SPECIALIST |
| Phone | 3154546000 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN20272 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| DFS AGENT, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| BANGASH MARYAM DDS | Manager | 1291 Peregrine Way, Weston, FL, 33327 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000058957 | ASPEN DENTAL | EXPIRED | 2018-05-15 | 2023-12-31 | No data | 281 SANDERS CREEK PARKWAY, EAST SYRACUSE, NY, 13057 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-21 | 1291 Peregrine Way, Weston, FL 33327 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-21 | 1291 Peregrine Way, Weston, FL 33327 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-25 | DFS Agent LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-12 | 1760 N Jog Rd Ste 150, West Palm Beach, FL 33411 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-02-06 |
| ANNUAL REPORT | 2020-01-25 |
| ANNUAL REPORT | 2019-03-06 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-02-15 |
| ANNUAL REPORT | 2016-03-12 |
| Florida Limited Liability | 2015-07-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
