| Entity Name: | NORTHERN DENTAL GENERAL AND COSMETIC DENTISTRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Feb 2016 (9 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 14 Dec 2017 (7 years ago) |
| Document Number: | L16000042325 |
| FEI/EIN Number | 81-1674922 |
| Address: | 5651 Naples Blvd, Naples, FL 34109 |
| Mail Address: | 5651 NAPLES BLVD, NAPLES, FL 34109 |
| ZIP code: | 34109 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164877395 | 2016-04-25 | 2016-04-25 | 5651 NAPLES BLVD, NAPLES, FL, 341092023, US | 5651 NAPLES BLVD, NAPLES, FL, 341092023, US | |||||||||||||||||||||||
|
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| Phone | +1 239-431-5666 |
Authorized person
| Name | SHANNON NOVAK |
| Role | MANAGER |
| Phone | 2394315666 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN20711 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016807000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NOVAK, SHANNON | Agent | 5651 NAPLES BLVD, NAPLES, FL 34109 |
| Name | Role | Address |
|---|---|---|
| NOVAK, SHANNON E | Manager | 5651 NAPLES BLVD, NAPLES, FL 34109 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-01-18 | 5651 Naples Blvd, Naples, FL 34109 | No data |
| LC STMNT OF RA/RO CHG | 2017-12-14 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-12-14 | 5651 Naples Blvd, Naples, FL 34109 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-12-14 | NOVAK, SHANNON | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-12-14 | 5651 NAPLES BLVD, NAPLES, FL 34109 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-22 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-01-18 |
| CORLCRACHG | 2017-12-14 |
| ANNUAL REPORT | 2017-01-12 |
| Florida Limited Liability | 2016-02-29 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
