| Entity Name: | MIDDLEBURG DENTAL PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Oct 2021 (3 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 08 Nov 2021 (3 years ago) |
| Document Number: | L21000433977 |
| FEI/EIN Number | 87-2961383 |
| Address: | 1178 BLANDING BLVD, MIDDLEBURG, FL, 32068 |
| Mail Address: | PO BOX 634, PONTE VEDRA BEACH, FL, 32004 |
| ZIP code: | 32068 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528703691 | 2022-05-03 | 2023-06-20 | PO BOX 70887, CLEVELAND, OH, 441900887, US | 1789 BLANDING BLVD, MIDDLEBURG, FL, 32068, US | |||||||||||||
|
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| Phone | +1 315-454-6000 |
Authorized person
| Name | JONG YUN PARK |
| Role | OWNER |
| Phone | 3154546000 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PARK JONG YUN | Agent | 130 Corridor Rd., Ponte Vedra Beach, FL, 32004 |
| Name | Role | Address |
|---|---|---|
| Park Jong yun | Auth | PO BOX 634, PONTE VEDRA BEACH, FL, 32004 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000050189 | ASPEN DENTAL | ACTIVE | 2022-04-20 | 2027-12-31 | No data | 281 SANDERS CREEK PARKWAY, EAST SYRACUSE, NY, 13057 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-04 | 130 Corridor Rd., PO Box 634, Ponte Vedra Beach, FL 32004 | No data |
| LC NAME CHANGE | 2021-11-08 | MIDDLEBURG DENTAL PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-01-18 |
| LC Name Change | 2021-11-08 |
| Florida Limited Liability | 2021-10-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
