| Entity Name: | COASTAL PERIODONTICS PRACTICE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
COASTAL PERIODONTICS PRACTICE, PLLC 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 04 Aug 2020 (5 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 21 Aug 2020 (5 years ago) |
| Document Number: | L20000234626 |
| FEI/EIN Number |
85-2639350
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL, 32548, US |
| Mail Address: | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL, 32548, US |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205449584 | 2020-08-26 | 2020-08-26 | 82 BEAL PKWY SW, FORT WALTON BEACH, FL, 325485331, US | 82 BEAL PKWY SW, FORT WALTON BEACH, FL, 325485331, US | |||||||||||||
|
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| Phone | +1 850-862-6666 |
Authorized person
| Name | FAITH GASKINS |
| Role | DIRECTOR OF CREDENTIALING |
| Phone | 9728693789 |
Taxonomy
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BARTRUFF JEFFREY D.M.D. | Manager | 3961 INDIAN TRAIL, DESTIN, FL, 32541 |
| BAUMAN STEVEN B | Agent | 909 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT AND NAME CHANGE | 2020-08-21 | COASTAL PERIODONTICS PRACTICE, PLLC | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-28 |
| LC Amendment and Name Change | 2020-08-21 |
| Florida Limited Liability | 2020-08-04 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
