| Entity Name: | BRAVAZ DENTAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Jan 2021 (4 years ago) |
| Document Number: | L21000013039 |
| FEI/EIN Number | 86-1497879 |
| Address: | 4700 SHERIDAN ST, HOLLYWOOD, FL, 33021, US |
| Mail Address: | 4700 sheridan st,, Hollywood, FL, 33021, US |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265011688 | 2021-04-04 | 2021-04-04 | 4700 SHERIDAN ST STE A1, HOLLYWOOD, FL, 330213416, US | 4700 SHERIDAN ST STE A1, HOLLYWOOD, FL, 330213416, US | |||||||||||||||||
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| Phone | +1 954-966-1166 |
Authorized person
| Name | DR. LISSANDRA M VAZQUEZ GRILLO |
| Role | MANAGER |
| Phone | 9549661166 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PPO DENTAL INSURANCE |
| Number | 1952831711 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRAVAZ DENTAL LLC- 401(K) | 2023 | 861497879 | 2024-09-03 | BRAVAZ DENTAL LLC | 1 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-03 |
| Name of individual signing | NICK RICE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ GRILLO LISSANDRA M | Agent | 10519 W 33 RD CT, HIALEAH, FL, 33018 |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ GRILLO LISSANDRA M | Manager | 105 19 W 33 RD CT, HIALEAH, FL, 33018 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-01-23 | 4700 SHERIDAN ST, SUITE A.1, HOLLYWOOD, FL 33021 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-05-12 | 4700 SHERIDAN ST, SUITE A.1, HOLLYWOOD, FL 33021 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-28 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-23 |
| Florida Limited Liability | 2021-01-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
