| Entity Name: | PALM BEACH GARDENS ORTHO LOCATION LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PALM BEACH GARDENS ORTHO LOCATION LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 09 Jul 2019 (6 years ago) |
| Date of dissolution: | 22 Sep 2023 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (2 years ago) |
| Document Number: | L19000176825 |
| FEI/EIN Number |
842669793
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4362 NORTHLAKE BLVD., 114, PALM BEACH GARDENS, FL, 33410, US |
| Mail Address: | 22 WESTEDGE ST, 107B, CHARLESTON, SC, 29403, US |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518505692 | 2019-12-19 | 2021-06-02 | 4362 NORTHLAKE BLVD STE 114, PALM BEACH GARDENS, FL, 334106269, US | 4362 NORTHLAKE BLVD STE 114, PALM BEACH GARDENS, FL, 334106269, US | |||||||||||||||||||||
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| Phone | +1 561-658-4100 |
| Fax | 8663332309 |
Authorized person
| Name | MRS. BRENDA COOPER |
| Role | INSURANCE COORDINATOR |
| Phone | 5616584100 |
Taxonomy
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105737100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SAVASTANO NICK JJR. | Manager | 975 SAVANNAH HWY., SUITE 107B, CHARLESTON, SC, 29407 |
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000063705 | THE SMILE STORE | ACTIVE | 2020-06-08 | 2025-12-31 | - | 22 WESTEDGE STREET,, SUITE 106 A, CHARLESTON, SC, 29403 |
| G19000086350 | CRESCENT ORTHODONTIC SPECIALISTS | EXPIRED | 2019-08-15 | 2024-12-31 | - | 975 SAVANNAH HWY., STE. 107B, CHARLESTON, SC, 29407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | - | - |
| LC REVOCATION OF DISSOLUTION | 2022-07-26 | - | - |
| LC VOLUNTARY DISSOLUTION | 2022-03-29 | - | - |
| LC AMENDMENT | 2021-01-15 | - | - |
| CHANGE OF MAILING ADDRESS | 2021-01-15 | 4362 NORTHLAKE BLVD., 114, PALM BEACH GARDENS, FL 33410 | - |
| LC STMNT OF RA/RO CHG | 2019-08-12 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2019-08-12 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J23000069153 | ACTIVE | 50-2021-CA-011083-XXXX-MB | 15TH JUDICIAL CIRCUIT COURT | 2023-02-01 | 2028-02-17 | $412,485.37 | TIAA, FSB, PO BOX 1283, CHARLOTTE, NC 28201 |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2024-01-16 |
| LC Revocation of Dissolution | 2022-07-26 |
| LC Voluntary Dissolution | 2022-03-29 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-03-19 |
| LC Amendment | 2021-01-15 |
| ANNUAL REPORT | 2020-01-15 |
| CORLCRACHG | 2019-08-12 |
| Florida Limited Liability | 2019-07-09 |
Date of last update: 02 May 2025
Sources: Florida Department of State
