| Entity Name: | FOREST PARK DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 25 May 2017 (8 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L17000115652 |
| FEI/EIN Number | 82-2014611 |
| 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 | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922529916 | 2017-06-29 | 2017-06-29 | 3150 ZELDA CT, MONTGOMERY, AL, 361062607, US | 2620 JENKS AVE, PANAMA CITY, FL, 324054311, US | |||||||||||||||
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| Phone | +1 334-676-2320 |
| Phone | +1 850-785-8586 |
Authorized person
| Name | SUSAN STEWART |
| Role | ADMINISTRATOR |
| Phone | 3346762320 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FOREST PARK DENTAL, PLLC 401(K) PLAN | 2023 | 822014611 | 2024-02-12 | FOREST PARK DENTAL, PLLC | 18 | |||||||||||||
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| FOREST PARK DENTAL, PLLC 401(K) PLAN | 2022 | 822014611 | 2023-10-04 | FOREST PARK DENTAL, PLLC | 19 | |||||||||||||
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| FOREST PARK DENTAL, PLLC 401(K) PLAN | 2021 | 822014611 | 2022-10-15 | FOREST PARK DENTAL, PLLC | 18 | |||||||||||||
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| FOREST PARK DENTAL, PLLC 401(K) PLAN | 2020 | 822014611 | 2021-10-14 | FOREST PARK DENTAL, PLLC | 15 | |||||||||||||
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| 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 | 2022-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-23 | 2620 JENKS AVE., PANAMA CITY, FL 32401 | 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 |
| CHANGE OF PRINCIPAL ADDRESS | 2019-11-22 | 707 JENKS AVE., PANAMA CITY, FL 32405 | No data |
| REINSTATEMENT | 2019-11-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-23 |
| REINSTATEMENT | 2019-11-22 |
| ANNUAL REPORT | 2018-04-16 |
| Florida Limited Liability | 2017-05-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
