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  5. AMELIA DENTAL GROUP, PLLC

AMELIA DENTAL GROUP, PLLC - Florida Company Profile

Company Details

Entity Name: AMELIA DENTAL GROUP, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

AMELIA DENTAL GROUP, PLLC 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: 15 Oct 2015 (10 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 23 Jan 2024 (a year ago)
Document Number: L15000175409
FEI/EIN Number 47-5341164

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034, US
Mail Address: 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034, US
ZIP code: 32034
County: Nassau
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1649350349 2006-10-17 2015-12-21 1947 CITRONA DRIVE, FERNANDINA BEACH, FL, 32034, US 1947 CITRONA DRIVE, FERNANDINA BEACH, FL, 32034, US

Contacts
Phone +1 904-261-7181
Fax 9042619797

Authorized person
Name DR. LAURIE KITSON
Role SEC
Phone 9042617181

Taxonomy
Taxonomy Code 122300000X - Dentist
License Number DN15429
State FL
Is Primary Yes
Taxonomy Code 122300000X - Dentist
License Number DN3529
State FL
Is Primary No
Taxonomy Code 122300000X - Dentist
License Number DN17599
State FL
Is Primary No
Taxonomy Code 122300000X - Dentist
License Number DN20603
State FL
Is Primary No
Taxonomy Code 122300000X - Dentist
License Number DN21208
State FL
Is Primary No
Taxonomy Code 1223E0200X - Endodontist
License Number DN11327
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2022 475341164 2023-10-12 AMELIA DENTAL GROUP, PLLC 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 32034
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2021 475341164 2022-10-12 AMELIA DENTAL GROUP, PLLC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2020 475341164 2021-10-11 AMELIA DENTAL GROUP, PLLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492

Signature of
Role Plan administrator
Date 2021-10-11
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-11
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2019 475341164 2020-06-30 AMELIA DENTAL GROUP, PLLC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492

Signature of
Role Plan administrator
Date 2020-06-30
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-30
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2018 475341164 2019-04-25 AMELIA DENTAL GROUP, PLLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492

Signature of
Role Plan administrator
Date 2019-04-25
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-04-25
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2017 475341164 2018-05-21 AMELIA DENTAL GROUP, PLLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492

Signature of
Role Plan administrator
Date 2018-05-21
Name of individual signing JOSHUA BIETENHOLV
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-21
Name of individual signing JOSHUA BIETENHOLV
Valid signature Filed with authorized/valid electronic signature
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2016 475341164 2017-05-17 AMELIA DENTAL GROUP, PLLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492

Signature of
Role Plan administrator
Date 2017-05-17
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-17
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
AMELIA DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN AND TRUST 2015 592097256 2016-09-13 AMELIA DENTAL GROUP, PLLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-07-01
Business code 621210
Sponsor’s telephone number 9042617181
Plan sponsor’s address 1947 CITRONA DRIVE, BUILDING B, FERNANDINA BEACH, FL, 320344492

Signature of
Role Plan administrator
Date 2016-09-13
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-13
Name of individual signing JOSHUA BIETENHOLZ
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
BIETENHOLZ JOSHUA ODMD Manager 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034
Blazejewski Justin EDMD Manager 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034
GARRETT STEVEN ADMD Manager 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034
MOKRIS JENNIFER LDMD Manager 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034
Mokris Jennifer LDMD Agent 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034
JUSTIN E.BLAZEJEWSKI,DMD Manager 1947 CITRONA DR, FERNANDINA BEACH, FL, 32034

Events

Event Type Filed Date Value Description
LC AMENDMENT 2024-01-23 - -
CHANGE OF PRINCIPAL ADDRESS 2024-01-22 1947 CITRONA DR, FERNANDINA BEACH, FL 32034 -
CHANGE OF MAILING ADDRESS 2024-01-22 1947 CITRONA DR, FERNANDINA BEACH, FL 32034 -
REGISTERED AGENT NAME CHANGED 2024-01-22 Mokris, Jennifer L, DMD -
REGISTERED AGENT ADDRESS CHANGED 2024-01-22 1947 CITRONA DR, FERNANDINA BEACH, FL 32034 -
LC AMENDMENT 2019-10-28 - -

Documents

Name Date
LC Amendment 2024-01-23
ANNUAL REPORT 2024-01-22
ANNUAL REPORT 2023-03-14
ANNUAL REPORT 2022-02-18
ANNUAL REPORT 2021-02-12
ANNUAL REPORT 2020-02-21
LC Amendment 2019-10-28
ANNUAL REPORT 2019-03-13
ANNUAL REPORT 2018-02-16
ANNUAL REPORT 2017-01-27

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3888127208 2020-04-27 0491 PPP 1947 CITRONA DR Bldg 4, FERNANDINA BEACH, FL, 32034-4492
Loan Status Date 2021-01-12
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 290200
Loan Approval Amount (current) 290200
Undisbursed Amount 0
Franchise Name -
Lender Location ID 88793
Servicing Lender Name First Federal Bank
Servicing Lender Address 4705 W US Hwy 90, LAKE CITY, FL, 32055-4884
Rural or Urban Indicator R
Hubzone N
LMI Y
Business Age Description Unanswered
Project Address FERNANDINA BEACH, NASSAU, FL, 32034-4492
Project Congressional District FL-04
Number of Employees 27
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 88793
Originating Lender Name First Federal Bank
Originating Lender Address LAKE CITY, FL
Gender Female Owned
Veteran Unanswered
Forgiveness Amount 291958.98
Forgiveness Paid Date 2021-02-12

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BIETENHOLZ JOSHUA ODMD

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GARRETT STEVEN ADMD

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Companies related by address

1947 CITRONA DR, FERNANDINA BEACH, FL, 32034, US

LAURIE A. KITSON, DMD, PLLC STEVEN A. GARRETT, DMD, PLLC JUSTIN E. BLAZEJEWSKI, P.L.L.C. OWENS, VAN ETTA, KITSON AND BIETENHOLZ, P.A.

1947 CITRONA DR, FERNANDINA BEACH, FL, 32034, US

LAURIE A. KITSON, DMD, PLLC STEVEN A. GARRETT, DMD, PLLC JUSTIN E. BLAZEJEWSKI, P.L.L.C. OWENS, VAN ETTA, KITSON AND BIETENHOLZ, P.A.

Date of last update: 03 Apr 2025

Sources: Florida Department of State

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