| Entity Name: | PENSACOLA PATRIOT DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 Jul 2021 (4 years ago) |
| Document Number: | L21000329369 |
| FEI/EIN Number | 87-1820690 |
| Address: | 2570 TEN MILE RD, MILTON, FL 32571 |
| Mail Address: | 2570 TEN MILE RD, MILTON, FL 32571 |
| ZIP code: | 32571 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629742226 | 2021-08-06 | 2021-08-06 | 4627 N DAVIS HWY STE A, PENSACOLA, FL, 325032364, US | 4627 N DAVIS HWY STE A, PENSACOLA, FL, 325032364, US | |||||||||||||
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| Phone | +1 850-477-1120 |
Authorized person
| Name | DR. JOHN KEITH LISONBEE |
| Role | CEO |
| Phone | 8507581844 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PENSACOLA PATRIOT DENTAL PLLC 401(K) PLAN | 2023 | 871820690 | 2024-05-20 | PENSACOLA PATRIOT DENTAL PLLC | 0 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-20 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| JOHN LISONBEE, DMD | Agent | 2570 TEN MILE RD, MILTON, FL 32571 |
| Name | Role | Address |
|---|---|---|
| JOHN LISONBEE, DMD | Authorized Member | 2570 TEN MILE RD, MILTON, FL 32571 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-03-19 |
| ANNUAL REPORT | 2022-07-25 |
| Florida Limited Liability | 2021-07-16 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
