| Entity Name: | EAST LAKE DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Aug 2018 (6 years ago) |
| Document Number: | L18000205946 |
| FEI/EIN Number | 83-1881665 |
| Address: | 903 N Narcoossee Rd, Saint Cloud, FL, 34771, US |
| Mail Address: | 903 N Narcoossee Rd, Saint Cloud, FL, 34771, US |
| ZIP code: | 34771 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518421924 | 2019-01-30 | 2019-01-30 | 4352 SUMMER BREEZE WAY, KISSIMMEE, FL, 347449603, US | 903 N. NARCOOSSEE RD, ST. CLOUD, FL, 34771, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 321-236-1393 |
Authorized person
| Name | DR. CHACHY REEMA PHILIP |
| Role | OWNER |
| Phone | 4073464873 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PHILIP CHACHY R | Agent | 903 N Narcoossee Rd, Saint Cloud, FL, 34771 |
| Name | Role | Address |
|---|---|---|
| PHILIP CHACHY R | Manager | 903 N Narcoossee Rd, Saint Cloud, FL, 34771 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000014721 | EAST LAKE FAMILY DENTAL | ACTIVE | 2019-01-28 | 2029-12-31 | No data | 903 N NARCOOSSEE RD, SAINT CLOUD, FL, 34771 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-05 | 903 N Narcoossee Rd, Saint Cloud, FL 34771 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-08-14 | 903 N Narcoossee Rd, Saint Cloud, FL 34771 | No data |
| CHANGE OF MAILING ADDRESS | 2020-08-14 | 903 N Narcoossee Rd, Saint Cloud, FL 34771 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-11 |
| ANNUAL REPORT | 2022-02-18 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-08-14 |
| ANNUAL REPORT | 2019-02-19 |
| Florida Limited Liability | 2018-08-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
