| Entity Name: | AZGAN DENTAL MANAGEMENT COMPANY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Oct 2021 (3 years ago) |
| Document Number: | L21000459440 |
| FEI/EIN Number | 87-3227057 |
| Address: | 109 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| Mail Address: | 109 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| ZIP code: | 33418 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760106967 | 2022-09-30 | 2022-09-30 | 1465 NW SAINT LUCIE WEST BLVD, PORT ST LUCIE, FL, 349861968, US | 1465 NW SAINT LUCIE WEST BLVD, PORT ST LUCIE, FL, 349861968, US | |||||||||||||||||||||
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| Phone | +1 772-348-4403 |
Authorized person
| Name | SUZEL GONZALEZ |
| Role | BILLING DIRECTOR |
| Phone | 7728124903 |
Taxonomy
| Taxonomy Code | 1223E0200X - Endodontist |
| Is Primary | Yes |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | No |
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| AZARI SCOTT | Agent | 109 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| Name | Role | Address |
|---|---|---|
| AZARI SCOTT | Manager | 109 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| GANKIN MIKHAIL M | Manager | 19501 W COUNTRY CLUB DR APT 2408, AVENTURA, FL, 33180 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000144660 | LUCIE DENTAL SPECIALISTS | ACTIVE | 2021-10-28 | 2026-12-31 | No data | 109 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-31 |
| Florida Limited Liability | 2021-10-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
