| Entity Name: | CITI DENTAL OF TAMPA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Jul 2020 (5 years ago) |
| Document Number: | L20000218689 |
| FEI/EIN Number | 85-2139825 |
| Address: | 9309 N FLORIDA AVE, STE 111, TAMPA, FL, 33612 |
| Mail Address: | 9309 N FLORIDA AVE, STE 111, TAMPA, FL, 33612 |
| ZIP code: | 33612 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518576727 | 2020-07-24 | 2020-07-24 | 9309 N FLORIDA AVE STE 111, TAMPA, FL, 336127237, US | 9309 N FLORIDA AVE STE 111, TAMPA, FL, 336127237, US | |||||||||||||||||||
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| Phone | +1 813-331-4578 |
Authorized person
| Name | DR. MICHAEL F. BATTLE |
| Role | OWNER |
| Phone | 7274231452 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100902000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BATTLE MICHAEL F | Agent | 5921 SKIMMER POINT BLVD, GULFORT, FL, 33707 |
| Name | Role | Address |
|---|---|---|
| BATTLE MICHAEL F | Manager | 5921 SKIMMER POINT BLVD, GULFPORT, FL, 33707 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-30 |
| Florida Limited Liability | 2020-07-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
