| Entity Name: | 5TH AVENUE DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Apr 2021 (4 years ago) |
| Document Number: | L21000160265 |
| FEI/EIN Number | 86-3450651 |
| Address: | 2142 N FEDERAL HWY, BOCA RATON, FL, 33431 |
| Mail Address: | 2455 EAST SUNRISE BLVD, SUITE 500, FORT LAUDERDALE, FL, 33304, US |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609446632 | 2021-06-30 | 2021-06-30 | 1500 N FEDERAL HWY STE 280, FT LAUDERDALE, FL, 333045600, US | 1500 N FEDERAL HWY STE 280, FT LAUDERDALE, FL, 333045600, US | |||||||||||||
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| Phone | +1 561-205-5000 |
Authorized person
| Name | DR. ANDREW FORREST |
| Role | PERIODONTIST/OWNER |
| Phone | 5612055000 |
Taxonomy
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ORANGE PARK DENTAL PARTNERS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| FORREST ANDREW D.M.D. | Manager | 2455 EAST SUNRISE BLVD, FORT LAUDERDALE, FL, 33304 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-03-18 | ORANGE PARK DENTAL PARTNERS | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-18 | 2455 EAST SUNRISE BLVD, SUITE 500, FORT LAUDERDALE, FL 33304 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-25 | 2142 N FEDERAL HWY, BOCA RATON, FL 33431 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-03-25 |
| Florida Limited Liability | 2021-04-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
