| Entity Name: | PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jul 2018 (7 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 04 Feb 2019 (6 years ago) |
| Document Number: | L18000164072 |
| FEI/EIN Number | 38-4087341 |
| Address: | 125 Enterprise Dr., Pittsburgh, PA, 15275, US |
| Mail Address: | 125 Enterprise Dr., Pittsburgh, PA, 15275, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558840371 | 2018-08-13 | 2018-08-13 | 11 S MILL ST STE 200, NEW CASTLE, PA, 161013680, US | 3226 LAKE WASHINGTON RD STE 16, MELBOURNE, FL, 329347620, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 724-698-2500 |
| Phone | +1 321-255-1991 |
Authorized person
| Name | ANNETTE MARLOW |
| Role | CREDENTIALING SUPERVISOR |
| Phone | 7246982119 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Louis Spelios | Member | 125 Enterprise Drive, Pittsburgh, PA, 15275 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-09 | 125 Enterprise Dr., Suite 200, Pittsburgh, PA 15275 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-09 | 125 Enterprise Dr., Suite 200, Pittsburgh, PA 15275 | No data |
| LC STMNT OF RA/RO CHG | 2019-02-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-04 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-04 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-04-18 |
| CORLCRACHG | 2019-02-04 |
| Florida Limited Liability | 2018-07-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
