| Entity Name: | JUPITER PEDIATRIC DENTISTRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Mar 2018 (7 years ago) |
| Document Number: | L18000077076 |
| FEI/EIN Number | 83-1075351 |
| Address: | 654 W INDIANTOWN RD, SUITE 102, JUPITER, FL 33458 |
| Mail Address: | 654 W INDIANTOWN RD, SUITE 102, JUPITER, FL 33458 |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619432747 | 2019-02-03 | 2019-02-03 | 654 W INDIANTOWN RD STE 102, JUPITER, FL, 334587546, US | 654 W INDIANTOWN RD STE 102, JUPITER, FL, 334587546, US | |||||||||||||||||||||
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| Phone | +1 561-747-3338 |
| Fax | 5612772510 |
Authorized person
| Name | DR. ALYSSA LYNN BENITEZ |
| Role | OWNER |
| Phone | 5617473338 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1922521822 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BENITEZ, ALYSSA L | Agent | 654 W INDIANTOWN RD, SUITE 102, JUPITER, FL 33458 |
| Name | Role | Address |
|---|---|---|
| BENITEZ, ALYSSA L | Manager | 654 W INDIANTOWN RD SUITE 102, JUPITER, FL 33458 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000066889 | PEDIATRIC DENTISTRY OF JUPITER | EXPIRED | 2018-06-10 | 2023-12-31 | No data | 654 W INDIANTOWN RD, STE 102, JUPITER, FL, 33458 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-04-04 |
| Florida Limited Liability | 2018-03-26 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
