| Entity Name: | ALTAMONTE SPRINGS DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Sep 2018 (6 years ago) |
| Document Number: | L18000216245 |
| FEI/EIN Number | 83-1910714 |
| Address: | 499 E. Central Pkwy, Altamonte Springs, FL, 32701, US |
| Mail Address: | 499 E. Central Pkwy, Altamonte Springs, FL, 32701, US |
| ZIP code: | 32701 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679109920 | 2020-03-19 | 2020-03-19 | 499 E CENTRAL PKWY STE 200, ALTAMONTE SPRINGS, FL, 327013450, US | 499 E CENTRAL PKWY STE 200, ALTAMONTE SPRINGS, FL, 327013450, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-831-3959 |
Authorized person
| Name | PETER KELLY |
| Role | OWNER |
| Phone | 4103031528 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | DN12540 |
| State | FL |
| Issuer | STATE LICENSE |
| Number | DN19430 |
| State | FL |
| Issuer | STATE LICENSE |
| Number | DN23428 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KELLY PETER | Agent | 499 E. Central Pkwy, Altamonte Springs, FL, 32701 |
| Name | Role | Address |
|---|---|---|
| KELLY PETER | Manager | 499 E. Central Pkwy, Altamonte Springs, FL, 32701 |
| Stallard Derek | Manager | 499 E. Central Pkwy, Altamonte Springs, FL, 32701 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000066607 | PALM SPRINGS DENTAL ASSOCIATES | ACTIVE | 2024-05-24 | 2029-12-31 | No data | 499 E CENTRAL PKWY, UNIT 200, ALTAMONTE, FL, 32701 |
| G19000081631 | PALM SPRINGS DENTAL, PLLC | ACTIVE | 2019-07-31 | 2029-12-31 | No data | 499 E CENTRAL PKWY #200, ALTAMONTE SPRINGS, FL, 32701 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-15 | 499 E. Central Pkwy, #200, Altamonte Springs, FL 32701 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-15 | 499 E. Central Pkwy, #200, Altamonte Springs, FL 32701 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-15 | 499 E. Central Pkwy, #200, Altamonte Springs, FL 32701 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-01-23 |
| ANNUAL REPORT | 2021-01-12 |
| AMENDED ANNUAL REPORT | 2020-06-15 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-23 |
| Florida Limited Liability | 2018-09-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
