| Entity Name: | MICHAEL E. PATCH DDS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Feb 2021 (4 years ago) |
| Document Number: | L21000088787 |
| FEI/EIN Number | 862506985 |
| Address: | 10609 OLD SAINT AUGUSTINE ROAD, SUITE 3, JACKSONVILLE, FL, 32257, US |
| Mail Address: | 10609 OLD SAINT AUGUSTINE ROAD, SUITE 3, JACKSONVILLE, FL, 32257, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356014229 | 2021-07-27 | 2021-07-27 | 10609 OLD SAINT AUGUSTINE RD STE 3, JACKSONVILLE, FL, 322571019, US | 10609 OLD SAINT AUGUSTINE RD STE 3, JACKSONVILLE, FL, 322571019, US | |||||||||||||
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| Phone | +1 904-268-1331 |
Authorized person
| Name | MICHAEL PATCH |
| Role | OWNER |
| Phone | 9042681331 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL E. PATCH DDS 401(K)PROFIT SHARING PLAN | 2023 | 862506985 | 2024-06-28 | MICHAEL E. PATCH DDS PLLC | 13 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-28 |
| Name of individual signing | MICHAEL E. PATCH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1997-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 9042681331 |
| Plan sponsor’s address | 10609 OLD ST. AUGUSTINE ROAD, SUITE 3, JACKSONVILLE, FL, 322571019 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-08 |
| Name of individual signing | MICHAEL E. PATCH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1997-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 9042681331 |
| Plan sponsor’s address | 10609 OLD ST. AUGUSTINE ROAD, SUITE 3, JACKSONVILLE, FL, 322571019 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-08 |
| Name of individual signing | MICHAEL PATCH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| PATCH MICHAEL E | Agent | 10609 OLD SAINT AUGUSTINE ROAD, JACKSONVILLE, FL, 32257 |
| Name | Role | Address |
|---|---|---|
| PATCH MICHAEL E | Manager | 10609 OLD SAINT AUGUSTINE ROAD, SUITE 3, JACKSONVILLE, FL, 32257 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-02-14 |
| Florida Limited Liability | 2021-02-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
