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SOUTH JACKSONVILLE DENTAL PLLC - Florida Company Profile

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Company Details

Entity Name: SOUTH JACKSONVILLE DENTAL PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 02 Oct 2015 (10 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 18 Oct 2016 (9 years ago)
Document Number: L15000167934
FEI/EIN Number 475226445
Address: 8440 BLANDING BLVD, JACKSONVILLE, FL, 32244, US
Mail Address: PO BOX 634, Ponte Vedra BEACH, FL, 32004, US
ZIP code: 32244
City: Jacksonville
County: Duval
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Park Jong Yun owne 130 Corridor Rd., Ponte Vedra Beach, FL, 32004
PARK JONG YUN Agent 8440 BLANDING BLVD, JACKSONVILLE, FL, 32244

National Provider Identifier

NPI Number:
1003287814

Authorized Person:

Name:
KIM VAN CAMP
Role:
PROVIDER RELATIONS SPECIALIST
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
3154105531

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000116365 ASPEN DENTAL EXPIRED 2015-11-16 2020-12-31 - 8440 BLANDING BLVD, JACKSONVILLE, FL, 32244

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2021-10-04 8440 BLANDING BLVD, JACKSONVILLE, FL 32244 -
CHANGE OF PRINCIPAL ADDRESS 2018-03-18 8440 BLANDING BLVD, JACKSONVILLE, FL 32244 -
REINSTATEMENT 2016-10-18 - -
REGISTERED AGENT NAME CHANGED 2016-10-18 PARK, JONG YUN -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 - -

Documents

Name Date
ANNUAL REPORT 2025-01-20
ANNUAL REPORT 2024-01-04
ANNUAL REPORT 2023-01-22
ANNUAL REPORT 2022-01-21
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-01-18
ANNUAL REPORT 2019-02-10
ANNUAL REPORT 2018-03-18
ANNUAL REPORT 2017-07-08
REINSTATEMENT 2016-10-18

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Date of last update: 02 Aug 2025

Sources: Florida Department of State