| Entity Name: | FREEPORT FAMILY DENTISTRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Mar 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Oct 2019 (5 years ago) |
| Document Number: | L17000054624 |
| FEI/EIN Number | 36-4862478 |
| Address: | 1361 Windward Ln, NICEVILLE, FL, 32578, US |
| Mail Address: | 1361 Windward Ln, NICEVILLE, FL, 32579, US |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790291425 | 2017-12-18 | 2017-12-18 | 30 BLUEBERRY RD, FREEPORT, FL, 324393016, US | 30 BLUEBERRY RD, FREEPORT, FL, 324393016, US | |||||||||||||
|
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| Phone | +1 850-835-4127 |
Authorized person
| Name | DR. JAMES J SHIRLEY |
| Role | DENTIST |
| Phone | 8508656703 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FREEPORT FAMILY DENTISTRY RETIREMENT PLAN & TRUST | 2023 | 364862478 | 2024-08-01 | FREEPORT FAMILY DENTISTRY, LLC | 9 | |||||||||||||
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| FREEPORT FAMILY DENTISTRY RETIREMENT PLAN & TRUST | 2022 | 364862478 | 2023-09-25 | FREEPORT FAMILY DENTISTRY, LLC | 7 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| Barker Farrar J | Agent | 60 Clayton Ln Ste B, Santa Rosa Beach, FL, 324598822 |
| Name | Role | Address |
|---|---|---|
| SHIRLEY JUSTIN D.M.D. | Authorized Member | 1361 Windward Ln, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| Shirley Lindsay LD.D.S. | Member | 1361 Windward Ln, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-10-01 | 1361 Windward Ln, NICEVILLE, FL 32578 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-01 | Barker, Farrar J | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-01 | 60 Clayton Ln Ste B, Santa Rosa Beach, FL 32459-8822 | No data |
| REINSTATEMENT | 2019-10-01 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2019-10-01 | 1361 Windward Ln, NICEVILLE, FL 32578 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| LC AMENDMENT | 2017-03-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-01-03 |
| ANNUAL REPORT | 2021-01-05 |
| ANNUAL REPORT | 2020-04-17 |
| REINSTATEMENT | 2019-10-01 |
| ANNUAL REPORT | 2018-03-15 |
| LC Amendment | 2017-03-28 |
| Florida Limited Liability | 2017-03-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
