| Entity Name: | PROFESSIONAL DENTAL ALLIANCE OF JACKSONVILLE SAN JOSE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Jan 2019 (6 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Apr 2024 (10 months ago) |
| Document Number: | L19000031339 |
| FEI/EIN Number | 36-4936688 |
| Address: | 125 Enterprise Drive, Suite 200, Pittsburgh, PA 15275 |
| Mail Address: | 125 Enterprise Drive, Suite 200, Pittsburgh, PA 15275 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578113254 | 2019-09-16 | 2019-09-16 | 11 S MILL ST STE 200, NEW CASTLE, PA, 161013680, US | 9776 SAN JOSE BLVD STE 7, JACKSONVILLE, FL, 322575464, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 904-201-3565 |
Authorized person
| Name | LAUREN HOWARD |
| Role | CREDENTIALING SPECIALIST |
| Phone | 7575765479 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Spelios, Louis, Dr. | Member | 125 Enterprise Drive, Suite 200 Pittsburgh, PA 15275 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000019913 | MANDARIN SMILES | EXPIRED | 2019-02-08 | 2024-12-31 | No data | 11 SOUTH MILL STREET, SUITE 200, NEW CASTLE, PA, 16101 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-04-30 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-30 | 125 Enterprise Drive, Suite 200, Pittsburgh, PA 15275 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 125 Enterprise Drive, Suite 200, Pittsburgh, PA 15275 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-05-26 | CORPORATION SERVICE COMPANY | No data |
| REINSTATEMENT | 2022-05-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-04-30 |
| REINSTATEMENT | 2022-05-26 |
| ANNUAL REPORT | 2020-04-16 |
| Florida Limited Liability | 2019-01-30 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
