| Entity Name: | FOREST PARK SMILES ON 11TH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 May 2017 (8 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L17000112889 |
| FEI/EIN Number | 82-2000504 |
| Address: | 707 Jenks Ave, PANAMA CITY, FL, 32405, US |
| Mail Address: | 707 Jenks Ave, PANAMA CITY, FL, 32405, US |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013438092 | 2017-06-29 | 2017-06-29 | 3150 ZELDA CT, MONTGOMERY, AL, 361062607, US | 1010 W 11TH ST, PANAMA CITY, FL, 324012042, US | |||||||||||||||
|
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| Phone | +1 334-676-2320 |
| Phone | +1 850-763-3622 |
Authorized person
| Name | SUSAN STEWART |
| Role | ADMINISTRATOR |
| Phone | 3346762320 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| BLUE WATERS DENTAL GROUP, PA. | Agent |
| Name | Role | Address |
|---|---|---|
| THOMPSON KRISTA | President | 707 Jenks Ave, PANAMA CITY, FL, 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REINSTATEMENT | 2019-11-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-11-22 | 707 Jenks Ave, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-11-22 | 707 Jenks Ave, PANAMA CITY, FL 32405 | No data |
| CHANGE OF MAILING ADDRESS | 2019-11-22 | 707 Jenks Ave, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-11-22 | Blue Waters Dental Group, PA. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2019-11-22 |
| ANNUAL REPORT | 2018-04-16 |
| Florida Limited Liability | 2017-05-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
