| Entity Name: | TDC PORT ST. LUCIE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Feb 2017 (8 years ago) |
| Document Number: | L17000030061 |
| FEI/EIN Number | 81-5465339 |
| Address: | 1385 GATLIN BLVD, PORT ST. LUCIE, FL 34952 |
| Mail Address: | 8794 W. Boynton Beach Blvd., Suite 218, Boynton Beach, FL 33472 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003471459 | 2019-05-01 | 2019-05-01 | 8794 W BOYNTON BEACH BLVD STE 110, BOYNTON BEACH, FL, 334724468, US | 1161 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL, 349525332, US | |||||||||||||||||||||||
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| Phone | +1 561-777-8980 |
| Phone | +1 772-335-7766 |
Authorized person
| Name | DR. SEAN TOMALTY |
| Role | CEO |
| Phone | 5617896611 |
Taxonomy
| Taxonomy Code | 1223E0200X - Endodontist |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Tomalty , Sean | Agent | 8794 W. Boynton Beach Blvd., SUITE 218, Boynton Beach, FL 33472 |
| Name | Role | Address |
|---|---|---|
| SEAN, TOMALTY A, Dr. | Manager | 8794 W. BOYNTON BEACH BLVD, 218 BOYNTON BEACH, FL 33473 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000083567 | MODERN DENTISTS OF PORT ST. LUCIE | ACTIVE | 2022-07-14 | 2027-12-31 | No data | 1385 SW GATLIN BLVD., PORT ST. LUCIE, FL, 33953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-13 | 8794 W. Boynton Beach Blvd., SUITE 218, Boynton Beach, FL 33472 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-21 | 1385 GATLIN BLVD, PORT ST. LUCIE, FL 34952 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-21 | Tomalty , Sean | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-06-16 |
| ANNUAL REPORT | 2019-01-30 |
| ANNUAL REPORT | 2018-01-15 |
| Florida Limited Liability | 2017-02-07 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
