| Entity Name: | GUIDED SMILES PROSTHODONTICS & IMPLANT CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jan 2021 (4 years ago) |
| Document Number: | L21000073435 |
| FEI/EIN Number | 86-2194293 |
| Address: | 153 Fort Wade Rd, Ponte Vedra, FL, 32081, US |
| Mail Address: | 13121 TOM MORRIS DRIVE, JACKSONVILLE, FL, 32224, US |
| ZIP code: | 32081 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114641339 | 2022-09-30 | 2022-09-30 | 153 FORT WADE ROAD, STE 100, PONTE VEDRA, FL, 32081, US | 153 FORT WADE ROAD, STE 100, PONTE VEDRA, FL, 32081, US | |||||||||||||
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| Phone | +1 904-395-5501 |
Authorized person
| Name | DR. ALONZO CARLOS BLACKMON |
| Role | AUTHORIZED OFFICIAL |
| Phone | 9043955501 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GUIDED SMILES PROSTHODONTICS & IMPLANT CENTER PLLC 401(K) PLAN | 2023 | 862194293 | 2024-05-13 | GUIDED SMILES PROSTHODONTICS & IMPLANT CENTER PLLC | 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 | 2024-05-13 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ALONZO CARLOS BLACKMON, DDS | Agent | 13121 TOM MORRIS DRIVE, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| ALONZO CARLOS BALCKMON, DDS | Authorized Member | 13121 TOM MORRIS DRIVE, JACKSONVILLE, FL, 32224 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-12 | 153 Fort Wade Rd, Suite 100, Ponte Vedra, FL 32081 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-03-08 |
| Florida Limited Liability | 2021-01-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
