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BLUE HEARTS DENTAL PLLC

Company Details

Entity Name: BLUE HEARTS DENTAL PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 17 Nov 2015 (9 years ago)
Document Number: L15000192576
FEI/EIN Number 47-5630084
Address: 4047 okeechobee blvd, west palm beach, FL, 33409, US
Mail Address: 4047 okeechobee blvd, west palm beach, FL, 33409, US
ZIP code: 33409
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1386007714 2016-04-02 2016-04-02 420 NW 47TH AVE APT 4, MIAMI, FL, 331262131, US 420 NW 47TH AVE APT 4, MIAMI, FL, 331262131, US

Contacts

Phone +1 786-282-3056

Authorized person

Name YANELIS PEREZ
Role PRESIDENT
Phone 7862823056

Taxonomy

Taxonomy Code 122300000X - Dentist
License Number DN21219
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUE HEARTS DENTAL 401(K) PLAN 2023 475630084 2024-05-16 BLUE HEARTS DENTAL 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621210
Sponsor’s telephone number 5616407600
Plan sponsor’s address 4047 OKEECHOBEE BLVD, SUITE 219, WEST PALM BEACH, FL, 33409

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2024-05-16
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
BLUE HEARTS DENTAL 401(K) PLAN 2022 475630084 2023-05-27 BLUE HEARTS DENTAL 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621210
Sponsor’s telephone number 5616407600
Plan sponsor’s address 4047 OKEECHOBEE BLVD, SUITE 219, WEST PALM BEACH, FL, 33409

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2023-05-27
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
BLUE HEARTS DENTAL 401(K) PLAN 2021 475630084 2022-06-01 BLUE HEARTS DENTAL 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621210
Sponsor’s telephone number 5616407600
Plan sponsor’s address 4047 OKEECHOBEE BLVD, SUITE 219, WEST PALM BEACH, FL, 33409

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2022-06-01
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PEREZ YANELIS Agent 4047 okeechobee blvd, west palm beach, FL, 33409

Secretary

Name Role Address
PEREZ YANELIS Secretary 4047 okeechobee blvd, west palm beach, FL, 33409

Manager

Name Role Address
PEREZ YANELIS Manager 4047 okeechobee blvd, west palm beach, FL, 33409

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000053303 MID-COUNTY DENTAL CENTER EXPIRED 2016-05-27 2021-12-31 No data 4047 OKEECHOBEE BLVD, SUITE 219, WEST PALM BEACH, FL, 33409

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-04-30 4047 okeechobee blvd, ste 219, west palm beach, FL 33409 No data
CHANGE OF MAILING ADDRESS 2018-04-30 4047 okeechobee blvd, ste 219, west palm beach, FL 33409 No data
REGISTERED AGENT ADDRESS CHANGED 2018-04-30 4047 okeechobee blvd, ste 219, west palm beach, FL 33409 No data
REGISTERED AGENT NAME CHANGED 2016-04-12 PEREZ, YANELIS No data

Documents

Name Date
ANNUAL REPORT 2024-04-03
ANNUAL REPORT 2023-04-06
ANNUAL REPORT 2022-04-29
ANNUAL REPORT 2021-04-30
ANNUAL REPORT 2020-05-19
ANNUAL REPORT 2019-05-26
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-04-29
ANNUAL REPORT 2016-04-12
Florida Limited Liability 2015-11-17

Date of last update: 02 Feb 2025

Sources: Florida Department of State