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  5. PEZZELLA FAMILY DENTISTRY LLC

PEZZELLA FAMILY DENTISTRY LLC

Company Details

Entity Name: PEZZELLA FAMILY DENTISTRY LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 18 Nov 2016 (8 years ago)
Document Number: L16000211704
FEI/EIN Number 814483516
Address: 901 TYRONE BLVD N., ST. PETERSBURG, FL, 33710, US
Mail Address: 901 TYRONE BLVD N., ST. PETERSBURG, FL, 33710, US
ZIP code: 33710
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801330246 2016-12-05 2016-12-05 1637 COUNTRY WALK DR, FLEMING ISLE, FL, 320038614, US 901 TYRONE BLVD N, SAINT PETERSBURG, FL, 337106332, US

Contacts
Phone +1 860-966-3564

Authorized person
Name DR. SALVATORE ROBERT PEZZELLA
Role DENTIST/ OWNER
Phone 8609663564

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number DN20846
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2023 814483516 2024-05-06 PEZZELLA FAMILY DENTISTRY 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7272253246
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

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 2024-05-06
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2022 814483516 2023-05-26 PEZZELLA FAMILY DENTISTRY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7272253246
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

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 2023-05-26
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2021 814483516 2022-06-01 PEZZELLA FAMILY DENTISTRY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7272253246
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

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
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2020 814483516 2021-04-17 PEZZELLA FAMILY DENTISTRY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7272253246
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-04-17
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2019 814483516 2020-06-16 PEZZELLA FAMILY DENTISTRY 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7273817888
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-06-16
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2018 814483516 2020-05-18 PEZZELLA FAMILY DENTISTRY 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7273817888
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-18
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
PEZZELLA FAMILY DENTISTRY 401(K) PLAN 2018 814483516 2019-07-17 PEZZELLA FAMILY DENTISTRY 2
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 7273817888
Plan sponsor’s address 901 TYRONE BLVD N, ST. PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PEZZELLA SALVATORE R Agent 901 TYRONE BLVD N., ST. PETERSBURG, FL, 33710

Manager

Name Role Address
PEZZELLA SALVATORE R Manager 901 TYRONE BLVD N., ST. PETERSBURG, FL, 33710

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2018-01-02 901 TYRONE BLVD N., ST. PETERSBURG, FL 33710 No data
REGISTERED AGENT ADDRESS CHANGED 2018-01-02 901 TYRONE BLVD N., ST. PETERSBURG, FL 33710 No data
CHANGE OF PRINCIPAL ADDRESS 2016-11-28 901 TYRONE BLVD N., ST. PETERSBURG, FL 33710 No data

Documents

Name Date
ANNUAL REPORT 2025-01-16
ANNUAL REPORT 2024-01-21
ANNUAL REPORT 2023-01-09
ANNUAL REPORT 2022-01-14
ANNUAL REPORT 2021-01-07
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-01-15
ANNUAL REPORT 2018-01-02
Florida Limited Liability 2016-11-18

Related by officers

PEZZELLA SALVATORE R

PEZZELLA HOLDINGS LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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