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  5. EXCEPTIONAL DENTAL OF SAINT PETERSBURG, LLC

EXCEPTIONAL DENTAL OF SAINT PETERSBURG, LLC - Florida Company Profile

Company Details

Entity Name: EXCEPTIONAL DENTAL OF SAINT PETERSBURG, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

EXCEPTIONAL DENTAL OF SAINT PETERSBURG, 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.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 30 Nov 2017 (7 years ago)
Document Number: L17000245850
FEI/EIN Number 82-3725715

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 3238 4th St N, Saint Petersburg, FL, 33704, US
Mail Address: 3238 4th St N, Saint Petersburg, FL, 33704, US
ZIP code: 33704
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255848768 2018-01-05 2018-01-05 3238 4TH ST N, ST PETERSBURG, FL, 337042127, US 3238 4TH ST N, ST PETERSBURG, FL, 337042127, US

Contacts
Phone +1 727-388-3429

Authorized person
Name DR. THUY NGUYEN
Role GENERAL DENTIST
Phone 7273883429

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number DN21089
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN 2023 823725715 2024-05-14 EXCEPTIONAL DENTAL OF SAINT PETERSBURG 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 7273883429
Plan sponsor’s address 3238 4TH ST N, ST. PETERSBURG, FL, 33704

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-14
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN 2022 823725715 2023-05-27 EXCEPTIONAL DENTAL OF SAINT PETERSBURG 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 7273883429
Plan sponsor’s address 3238 4TH ST N, ST. PETERSBURG, FL, 33704

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-27
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN 2021 823725715 2022-10-05 EXCEPTIONAL DENTAL OF SAINT PETERSBURG 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 7273883429
Plan sponsor’s address 3238 4TH ST N, ST. PETERSBURG, FL, 33704

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-10-05
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PROFIT SHARING PLAN & TRUST 2021 823725715 2022-06-28 EXCEPTIONAL DENTAL OF SAINT PETERSBURG 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 7273883429
Plan sponsor’s address 3238 4TH ST N, ST PETERSBURG, FL, 337042127

Signature of
Role Plan administrator
Date 2022-06-28
Name of individual signing THUY NGUYEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-28
Name of individual signing THUY NGUYEN
Valid signature Filed with authorized/valid electronic signature
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN 2020 823725715 2021-10-13 EXCEPTIONAL DENTAL OF SAINT PETERSBURG 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 7273883429
Plan sponsor’s address 3238 4TH ST N, ST. PETERSBURG, FL, 33704

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
DELASSEN JAN F Manager 3238 4th St N, Saint Petersburg, FL, 33704
NGUYEN THUY T Manager 3238 4th St N, Saint Petersburg, FL, 33704
DELASSEN JAN F Agent 3238 4th St N, Saint Petersburg, FL, 33704

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2019-01-17 3238 4th St N, Saint Petersburg, FL 33704 -
CHANGE OF MAILING ADDRESS 2019-01-17 3238 4th St N, Saint Petersburg, FL 33704 -
REGISTERED AGENT ADDRESS CHANGED 2019-01-17 3238 4th St N, Saint Petersburg, FL 33704 -

Documents

Name Date
ANNUAL REPORT 2024-02-10
ANNUAL REPORT 2023-03-07
ANNUAL REPORT 2022-01-23
ANNUAL REPORT 2021-02-01
ANNUAL REPORT 2020-02-10
ANNUAL REPORT 2019-01-17
ANNUAL REPORT 2018-04-26
Florida Limited Liability 2017-11-30

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8171568703 2021-04-07 0455 PPS 3238 4th St N, St Petersburg, FL, 33704-2127
Loan Status Date 2022-08-23
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 97230
Loan Approval Amount (current) 97230
Undisbursed Amount 0
Franchise Name -
Lender Location ID 121536
Servicing Lender Name Customers Bank
Servicing Lender Address 40 General Warren Blvd, Malvern, PA, 19355
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address St Petersburg, PINELLAS, FL, 33704-2127
Project Congressional District FL-14
Number of Employees 12
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 122043
Originating Lender Name WebBank
Originating Lender Address SALT LAKE CITY, UT
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 98460.69
Forgiveness Paid Date 2022-07-15
9195877302 2020-05-01 0455 PPP 3238 4TH ST N, ST. PETERSBURG, FL, 33704
Loan Status Date 2021-04-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 98635
Loan Approval Amount (current) 98635
Undisbursed Amount 0
Franchise Name -
Lender Location ID 122043
Servicing Lender Name WebBank
Servicing Lender Address 215 S State St, Ste 1000, SALT LAKE CITY, UT, 84111-2336
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address ST. PETERSBURG, PINELLAS, FL, 33704-0001
Project Congressional District FL-14
Number of Employees 13
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 122043
Originating Lender Name WebBank
Originating Lender Address SALT LAKE CITY, UT
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 99282.63
Forgiveness Paid Date 2021-02-16

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Companies related by address

3238 4th St N, Saint Petersburg, FL, 33704, US

THUY T. NGUYEN, D.D.S., LLC JAN F. DELASSEN, D.D.S., LLC

3238 4th St N, Saint Petersburg, FL, 33704, US

THUY T. NGUYEN, D.D.S., LLC JAN F. DELASSEN, D.D.S., LLC

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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