| Entity Name: | FL DENTAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jun 2021 (4 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 24 Apr 2024 (9 months ago) |
| Document Number: | L21000280735 |
| FEI/EIN Number | 87-1305432 |
| Address: | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| Mail Address: | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| ZIP code: | 33445 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750951299 | 2021-06-28 | 2023-07-10 | 4765 W ATLANTIC AVE, DELRAY BEACH, FL, 334453838, US | 4765 W ATLANTIC AVE, DELRAY BEACH, FL, 334453838, US | |||||||||||||||||||
|
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| Phone | +1 561-859-5052 |
| Fax | 9543746955 |
Authorized person
| Name | MS. VICTORIA SAMUELSON |
| Role | CEO |
| Phone | 5618595052 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | No |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| SAMUELSON VICTORIA | Manager | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| KIRSHBAUM RANDY | Manager | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000104778 | DELRAY DENTAL GROUP | ACTIVE | 2021-08-12 | 2026-12-31 | No data | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| G21000104780 | HALLANDALE DENTAL GROUP | ACTIVE | 2021-08-12 | 2026-12-31 | No data | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| G21000102905 | CORAL SPRINGS DENTAL GROUP | ACTIVE | 2021-08-07 | 2026-12-31 | No data | 4765 W ATLANTIC AVENUE, DELRAY BEACH, FL, 33445 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2024-04-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-24 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-24 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-03-07 |
| AMENDED ANNUAL REPORT | 2022-08-25 |
| AMENDED ANNUAL REPORT | 2022-08-17 |
| ANNUAL REPORT | 2022-07-13 |
| Florida Limited Liability | 2021-06-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
