| Entity Name: | BOLD CITY DERMATOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Dec 2019 (5 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 25 Jan 2021 (4 years ago) |
| Document Number: | L19000298864 |
| FEI/EIN Number | 84-4002325 |
| Address: | 316 PASEO REYES DRIVE, ST. AUGUSTINE, FL, 32095, US |
| Mail Address: | 316 PASEO REYES DRIVE, ST. AUGUSTINE, FL, 32095, US |
| ZIP code: | 32095 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538761655 | 2020-11-13 | 2021-01-26 | 316 PASEO REYES DR, ST AUGUSTINE, FL, 320958464, US | 316 PASEO REYES DR, ST AUGUSTINE, FL, 320958464, US | |||||||||||||||||||||||||||
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| Phone | +1 904-544-5800 |
| Fax | 9045445800 |
Authorized person
| Name | BISHR AL DABAGH |
| Role | OWNER |
| Phone | 7042301302 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 207NP0225X - Pediatric Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BOLD CITY DERMATOLOGY 401(K) PLAN | 2023 | 844002325 | 2024-07-22 | BOLD CITY DERMATOLOGY, LLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-22 |
| Name of individual signing | CHRIS HORNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BISHR AL DABAGH | Agent | 316 PASEO REYES DR., ST. AUGUSTINE, FL, 32095 |
| Name | Role | Address |
|---|---|---|
| AL DABAGH BISHR | Manager | 118 GATEWAY BLVD,, MOORESVILLE, NC, 33702 |
| Name | Role | Address |
|---|---|---|
| Ferrer-Bruker Sarah JDr. | Auth | 316 PASEO REYES DRIVE, ST. AUGUSTINE, FL, 32095 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-01-25 | BISHR AL DABAGH | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-08 | 316 PASEO REYES DRIVE, ST. AUGUSTINE, FL 32095 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-08 | 316 PASEO REYES DRIVE, ST. AUGUSTINE, FL 32095 | No data |
| LC AMENDMENT | 2020-06-04 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-12 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-07 |
| LC Amendment | 2020-06-04 |
| ANNUAL REPORT | 2020-04-21 |
| Florida Limited Liability | 2019-12-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
