| Entity Name: | JACKSONVILLE DENTISTRY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Jan 2021 (4 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 28 Dec 2023 (a year ago) |
| Document Number: | L21000048399 |
| FEI/EIN Number | 86-1439947 |
| Address: | 12058 San Jose Blvd, #102, Jacksonville, FL 32223 |
| Mail Address: | 3221 CONWAY RD, SUITE D, ORLANDO, FL 32812 |
| ZIP code: | 32223 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417541079 | 2021-02-24 | 2021-02-24 | 12058 SAN JOSE BLVD STE 102, JACKSONVILLE, FL, 322238669, US | 12058 SAN JOSE BLVD STE 102, JACKSONVILLE, FL, 322238669, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 904-880-3131 |
Authorized person
| Name | PETER KELLY |
| Role | OWNER |
| Phone | 4104103031 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | DN0013386 |
| State | FL |
| Issuer | STATE LICENSE |
| Number | DN19430 |
| State | FL |
| Issuer | STATE LICENSE |
| Number | DN21484 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROBINSON, MATTHEW | Agent | 3221 CONWAY RD, SUITE D, ORLANDO, FL 32812 |
| Name | Role | Address |
|---|---|---|
| KELLY, PETER | Manager | 3221 CONWAY RD STE D, ORLANDO, FL 32812 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000086525 | MANDARIN DENTAL CARE | ACTIVE | 2021-06-30 | 2026-12-31 | No data | 3221 CONWAY RD STE D, ORLANDO, FL, 32832 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2023-12-28 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 100000250571 |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-30 | 12058 San Jose Blvd, #102, Jacksonville, FL 32223 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| Merger | 2023-12-28 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-01-30 |
| Florida Limited Liability | 2021-01-26 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
