| Entity Name: | SAGE DENTAL OF AVALON PARK, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Sep 2021 (3 years ago) |
| Document Number: | L21000406563 |
| FEI/EIN Number | 87-2739333 |
| Address: | 6600 Congress Avenue, BOCA RATON, FL, 33487, US |
| Mail Address: | 6600 Congress Avenue, BOCA RATON, FL, 33487, US |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265194054 | 2021-10-08 | 2023-05-19 | 6600 CONGRESS AVE STE 150, BOCA RATON, FL, 334871213, US | 12990 TANJA KING BLVD, ORLANDO, FL, 328287380, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 561-999-9650 |
Authorized person
| Name | CINDY ROARK |
| Role | SVP, CHIEF CLINICAL OFFICER |
| Phone | 5619999650 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Roark Cindy | President | 6600 Congress Avenue, BOCA RATON, FL, 33487 |
| Name | Role |
|---|---|
| SAGE DENTAL GROUP OF FLORIDA, PLLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000118732 | SAGE DENTAL | ACTIVE | 2021-09-15 | 2026-12-31 | No data | 951 BROKEN SOUND PARKWAY SUITE 250, BOCA RATON, FL, 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-03 | 6600 Congress Avenue, Suite 150, BOCA RATON, FL 33487 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-03 | 6600 Congress Avenue, Suite 150, BOCA RATON, FL 33487 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| AMENDED ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-02-28 |
| Florida Limited Liability | 2021-09-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
