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PROVIDENCE DENTAL LLC - Florida Company Profile

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Company Details

Entity Name: PROVIDENCE DENTAL LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 05 Apr 2017 (8 years ago)
Date of dissolution: 25 Sep 2020 (5 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2020 (5 years ago)
Document Number: L17000076217
FEI/EIN Number 61-1843652
Address: 4501 S. SEMORAN BLVD., ORLANDO, FL, 32822
Mail Address: 4501 S. SEMORAN BLVD., ORLANDO, FL, 32822
ZIP code: 32822
City: Orlando
County: Orange
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MORALES HERMAN Manager 4501 S SEMORAN BLVD, ORLANDO, FL, 32822
Morales Herman Agent 4501 S. SEMORAN BLVD., ORLANDO, FL, 32822

National Provider Identifier

NPI Number:
1407330145

Authorized Person:

Name:
NADIA KAHOOK
Role:
CREDENTIALING CONSULTANT
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
4072860439

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 - -
REINSTATEMENT 2018-10-12 - -
REGISTERED AGENT NAME CHANGED 2018-10-12 Morales, Herman -
REGISTERED AGENT ADDRESS CHANGED 2018-10-12 4501 S. SEMORAN BLVD., ORLANDO, FL 32822 -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 - -

Documents

Name Date
ANNUAL REPORT 2019-05-01
REINSTATEMENT 2018-10-12
Florida Limited Liability 2017-04-05

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Date of last update: 03 Aug 2025

Sources: Florida Department of State