| Entity Name: | IMAGINE ORTHODONTIC STUDIO, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Jan 2020 (5 years ago) |
| Document Number: | L20000027973 |
| FEI/EIN Number | 84-4591173 |
| Address: | 3595 S Florida Ave, Lakeland, FL, 33803-4860, US |
| Mail Address: | 16305 Fishhawk Blvd, Lithia, FL, 33547, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578302774 | 2024-05-20 | 2024-05-28 | 1411 SAND LAKE RD STE D, ORLANDO, FL, 328097045, US | 1411 SAND LAKE RD STE D, ORLANDO, FL, 328097045, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 813-965-3536 |
| Phone | +1 833-467-2778 |
Authorized person
| Name | MICHAEL ANDREW HESS |
| Role | PART OWNER |
| Phone | 8139653536 |
Taxonomy
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IMAGINE ORTHODONTIC STUDIO LLC 401(K) PLAN | 2023 | 844591173 | 2024-10-03 | IMAGINE ORTHODONTIC STUDIO, PLLC | 18 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-10-03 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 8634624463 |
| Plan sponsor’s address | 3604 W. DE LEON STREET, TAMPA, FL, 33609 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-11 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| HESS MICHAEL A | Agent | 16305 Fishhawk Blvd., Lithia, FL, 33547 |
| Name | Role | Address |
|---|---|---|
| HESS MICHAEL A | Manager | 16305 Fishhawk Blvd., Lithia, FL, 33547 |
| POPAT PAIYAL | Manager | 3604 W. DeLeon Street, Tampa, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| Patel Samik | Mgr | 3604 W De Leon Street, Tampa, FL, 33609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-15 | 3595 S Florida Ave, Lakeland, FL 33803-4860 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-13 | 16305 Fishhawk Blvd., Lithia, FL 33547 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-28 | 3595 S Florida Ave, Lakeland, FL 33803-4860 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-01-28 |
| Florida Limited Liability | 2020-01-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
