| Entity Name: | SMITH ENDODONTICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Mar 2021 (4 years ago) |
| Document Number: | L21000135136 |
| FEI/EIN Number | 86-3080128 |
| Address: | 3166 ADDISON DRIVE, MELBOURE, FL, 32940, US |
| Mail Address: | 3166 ADDISON DRIVE, MELBOURE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164879052 | 2016-05-20 | 2016-05-20 | 1520 BUSINESS CENTER DR, SUITE 2, ORANGE PARK, FL, 320039011, US | 1520 BUSINESS CENTER DR, SUITE 2, ORANGE PARK, FL, 320039011, US | |||||||||||||||||||
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| Phone | +1 904-637-0028 |
| Fax | 9046448230 |
Authorized person
| Name | DR. MICHAEL R. SMITH |
| Role | OWNER |
| Phone | 9046370028 |
Taxonomy
| Taxonomy Code | 1223E0200X - Endodontist |
| License Number | DN13788 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SMITH ENDODONTICS | 2023 | 863080128 | 2024-09-25 | SMITH ENDODONTICS | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-25 |
| Name of individual signing | STEVEN SMITH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-06-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 7027430827 |
| Plan sponsor’s address | 3166 ADDISON DRIVE, MELBOURNE, FL, 32940 |
Signature of
| Role | Plan administrator |
| Date | 2023-12-27 |
| Name of individual signing | STEVEN SMITH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-06-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 7027430827 |
| Plan sponsor’s address | 3166 ADDISON DRIVE, MELBOURNE, FL, 32940 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-10 |
| Name of individual signing | STEVEN SMITH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| STEVE SMITH | Agent | 3166 ADDISON DRIVE, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| SMITH STEVE | Manager | 3166 ADDISON DRIVE, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-05 | STEVE, SMITH | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-02-25 |
| Florida Limited Liability | 2021-03-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
