| Entity Name: | PROVIDENCE DENTAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PROVIDENCE DENTAL LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| 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
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4501 S. SEMORAN BLVD., ORLANDO, FL, 32822 |
| Mail Address: | 4501 S. SEMORAN BLVD., ORLANDO, FL, 32822 |
| ZIP code: | 32822 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407330145 | 2018-09-19 | 2018-09-19 | 12450 E. COLONIAL DRIVE SUITE 124, ORLANDO, FL, 32826, US | 12450 E. COLONIAL DRIVE SUITE 124, ORLANDO, FL, 32826, US | |||||||||||||||||||||
|
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| Phone | +1 407-635-0704 |
| Fax | 4072860439 |
Authorized person
| Name | NADIA KAHOOK |
| Role | CREDENTIALING CONSULTANT |
| Phone | 9544465797 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MORALES HERMAN | Manager | 4501 S SEMORAN BLVD, ORLANDO, FL, 32822 |
| Morales Herman | Agent | 4501 S. SEMORAN BLVD., ORLANDO, FL, 32822 |
| 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 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-05-01 |
| REINSTATEMENT | 2018-10-12 |
| Florida Limited Liability | 2017-04-05 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
