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  5. BLUE WATER DENTAL OF ST. JOHNS, LLC

BLUE WATER DENTAL OF ST. JOHNS, LLC - Florida Company Profile

Company Details

Entity Name: BLUE WATER DENTAL OF ST. JOHNS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

BLUE WATER DENTAL OF ST. JOHNS, 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: 08 Feb 2016 (9 years ago)
Document Number: L16000026801
FEI/EIN Number 811397766

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 460 TOWN PLAZA AVENUE, PONTE VEDRA, FL, 32081, US
Mail Address: 460 TOWN PLAZA AVENUE, PONTE VEDRA, FL, 32081, US
ZIP code: 32081
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1821543513 2016-08-23 2016-08-23 334 WILLOW WINDS PKWY, SAINT JOHNS, FL, 322597268, US 460 TOWN PLAZA AVE, SUITE 210, PONTE VEDRA, FL, 320815139, US

Contacts
Phone +1 904-755-1966

Authorized person
Name DR. DAVID WALLACE SORENSEN
Role DENTIST/OWNER
Phone 9047551966

Taxonomy
Taxonomy Code 305R00000X - Preferred Provider Organization
License Number DN20719
State FL
Is Primary Yes

Other Provider Identifiers
Issuer INDIVIDUAL NPI
Number 1831508084
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2023 811397766 2024-10-03 BLUE WATER DENTAL OF ST. JOHNS 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2024-10-03
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2022 811397766 2023-09-28 BLUE WATER DENTAL OF ST. JOHNS 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2023-09-28
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2021 811397766 2022-10-03 BLUE WATER DENTAL OF ST. JOHNS 10
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2021 811397766 2022-10-03 BLUE WATER DENTAL OF ST. JOHNS 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2021 811397766 2022-10-03 BLUE WATER DENTAL OF ST. JOHNS 10
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2021 811397766 2022-10-03 BLUE WATER DENTAL OF ST. JOHNS 10
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2021 811397766 2022-10-03 BLUE WATER DENTAL OF ST. JOHNS 10
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2020 811397766 2021-10-08 BLUE WATER DENTAL OF ST. JOHNS 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2021-10-08
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
BLUE WATER DENTAL OF ST. JOHNS 401(K) PLAN 2019 811397766 2020-09-09 BLUE WATER DENTAL OF ST. JOHNS 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 9047551966
Plan sponsor’s address 460 TOWN PLAZA AVE STE 210, PONTE VEDRA, FL, 32081

Signature of
Role Plan administrator
Date 2020-09-09
Name of individual signing CHRISTINA OWEN
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
SORENSEN DAVID WD.M.D. President 460 TOWN PLAZA AVENUE, PONTE VEDRA, FL, 32081
SORENSEN DAVID WD.M.D. Agent 460 TOWN PLAZA AVENUE, PONTE VEDRA, FL, 32081

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2017-01-28 460 TOWN PLAZA AVENUE, Suite 210, PONTE VEDRA, FL 32081 -
CHANGE OF MAILING ADDRESS 2017-01-28 460 TOWN PLAZA AVENUE, Suite 210, PONTE VEDRA, FL 32081 -
REGISTERED AGENT ADDRESS CHANGED 2017-01-28 460 TOWN PLAZA AVENUE, Suite 210, PONTE VEDRA, FL 32081 -

Documents

Name Date
ANNUAL REPORT 2024-03-08
ANNUAL REPORT 2023-04-24
ANNUAL REPORT 2022-03-04
ANNUAL REPORT 2021-03-03
ANNUAL REPORT 2020-02-06
ANNUAL REPORT 2019-04-10
ANNUAL REPORT 2018-04-14
ANNUAL REPORT 2017-01-28
Florida Limited Liability 2016-02-08

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8225297106 2020-04-15 0491 PPP 334 Willow Winds Parkway, SAINT JOHNS, FL, 32259-7268
Loan Status Date 2021-08-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 76424.92
Loan Approval Amount (current) 76424.92
Undisbursed Amount 0
Franchise Name -
Lender Location ID 94425
Servicing Lender Name VyStar CU
Servicing Lender Address 76 S Laura St, JACKSONVILLE, FL, 32202
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address SAINT JOHNS, SAINT JOHNS, FL, 32259-7268
Project Congressional District FL-05
Number of Employees 8
NAICS code 621210
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 94425
Originating Lender Name VyStar CU
Originating Lender Address JACKSONVILLE, FL
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 77348.3
Forgiveness Paid Date 2021-07-06

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Date of last update: 01 Apr 2025

Sources: Florida Department of State

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