| Entity Name: | RUDOLPH M. WAGNER, DMD, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Apr 2021 (4 years ago) |
| Document Number: | L21000156446 |
| FEI/EIN Number | 863032687 |
| Address: | 2595 Tampa Rd, Ste I, Palm Harbor, FL, 34684, US |
| Mail Address: | 2595 Tampa Rd, Palm Harbor, FL, 34684, US |
| ZIP code: | 34684 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679146435 | 2021-07-20 | 2021-07-20 | 2595 TAMPA RD STE I, PALM HARBOR, FL, 346843131, US | 2595 TAMPA RD STE I, PALM HARBOR, FL, 346843131, US | |||||||||||||
|
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| Phone | +1 727-785-8847 |
Authorized person
| Name | RUDOLPH WAGNER |
| Role | ORTHODONTIST/ MANAGING MEMBER |
| Phone | 7277858847 |
Taxonomy
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WAGNER RUDOLPH | Agent | 2574 COCO PALM CIRCLE, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| WAGNER RUDOLPH | Manager | 2574 COCO PALM CIRCLE, WESLEY CHAPEL, FL, 33543 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-03 | 2595 Tampa Rd, Ste I, Palm Harbor, FL 34684 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-03 | 2595 Tampa Rd, Ste I, Palm Harbor, FL 34684 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-03-05 |
| ANNUAL REPORT | 2022-02-03 |
| Florida Limited Liability | 2021-04-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
