| Entity Name: | CLERMONT DENTISTRY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 29 Jan 2021 (4 years ago) |
| Date of dissolution: | 31 Aug 2021 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 31 Aug 2021 (3 years ago) |
| Document Number: | L21000052870 |
| Address: | 3221 CONWAY RD, STE D, ORLANDO, FL 32812 |
| Mail Address: | 3221 CONWAY RD, STE D, ORLANDO, FL 32812 |
| ZIP code: | 32812 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336714377 | 2021-05-21 | 2021-05-21 | 1580 HOOKS ST, CLERMONT, FL, 34711, US | 1580 HOOKS ST, CLERMONT, FL, 34711, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Name | DR. PETER KELLY |
| Role | OWNER |
| Phone | 4104103031 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | DN19430 |
| State | FL |
| Issuer | STATE LICENSE |
| Number | DN22019 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROBINSON, MATTHEW | Agent | 3221 CONWAY RD, STE D, ORLANDO, FL 32812 |
| Name | Role | Address |
|---|---|---|
| KELLY, PETER | Manager | 3221 CONWAY RD STE D, ORLANDO, FL 32812 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-08-31 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2021-08-31 |
| Florida Limited Liability | 2021-01-29 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
