| Entity Name: | LAKE VILLAGE DENTAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jan 2021 (4 years ago) |
| Document Number: | L21000019443 |
| FEI/EIN Number | 86-1649944 |
| Address: | 3261 UD HWY 27/441, E-1, FRUITLAND PARK, FL, 34731, US |
| Mail Address: | 3261 UD HWY 27/441, E-1, FRUITLAND PARK, FL, 34731, US |
| ZIP code: | 34731 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760073217 | 2021-01-28 | 2021-01-28 | 3261 S US HIGHWAY 27 # 441E-1, FRUITLAND PARK, FL, 347314497, US | 3261 S US HIGHWAY 27 # 441E-1, FRUITLAND PARK, FL, 347314497, US | |||||||||||||||
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| Phone | +1 352-314-2729 |
| Fax | 3523149889 |
Authorized person
| Name | DR. VAMSI KALLEPALLI |
| Role | DENTIST |
| Phone | 3523142729 |
Taxonomy
| Taxonomy Code | 1223D0001X - Public Health Dentist |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE VILLAGE DENTAL 401(K) PLAN | 2023 | 861649944 | 2024-05-28 | LAKE VILLAGE DENTAL | 0 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-28 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| M KERMALI, CPA, PA | Agent |
| Name | Role | Address |
|---|---|---|
| KALLEPALLI VAMSI | Authorized Member | 1214 EDWARDS LANE, ORLANDO, FL, 32804 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000085417 | LAKE HARRIS DENTAL | ACTIVE | 2021-06-28 | 2026-12-31 | No data | 3261 US HWY 27/441, E-1, FRUITLAND PARK, FL, 34731 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-23 | 922 WILLISTON PARK PT, 1310, LAKE MARY, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-23 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-03-24 |
| Florida Limited Liability | 2021-01-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
