| Entity Name: | W&J DENTAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Oct 2021 (3 years ago) |
| Document Number: | L21000448964 |
| FEI/EIN Number | 87-3145598 |
| Address: | 10231 E COLONIAL DR, ORLANDO, FL, 32817 |
| Mail Address: | 10231 E COLONIAL DR, ORLANDO, FL, 32817 |
| ZIP code: | 32817 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619633815 | 2021-11-11 | 2021-11-15 | 10231 E COLONIAL DR, ORLANDO, FL, 328174353, US | 10231 E COLONIAL DR, ORLANDO, FL, 328174353, US | |||||||||||||||||||||||||||
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| Phone | +1 407-985-2885 |
| Fax | 4079852887 |
Authorized person
| Name | DR. JOOD BAZERBASHI |
| Role | MANAGER |
| Phone | 8326618720 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1518048065 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1093317703 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ASSAF WASIM DR. | Agent | 7804 BLUE QUAIL LANE, ORLANDO, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| BAZERBASHI JOOD DR. | Manager | 257 KILLINGTON WAY, ORLANDO, FL, 32835 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000139938 | GLOWING SMILE DENTAL STUDIO | ACTIVE | 2021-10-18 | 2026-12-31 | No data | 10231 E COLONIAL DR, ORLANDO, FL, 32817 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-03-10 |
| Florida Limited Liability | 2021-10-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
