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BROWN DENTISTRY PLLC - Florida Company Profile

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Company Details

Entity Name: BROWN DENTISTRY PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 02 Nov 2021 (4 years ago)
Document Number: L21000474791
FEI/EIN Number 87-3454730
Address: 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073
Mail Address: 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073
ZIP code: 32073
City: Orange Park
County: Clay
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
BROWN ANDREW Manager 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073
PUCKETT JUSTIN Agent 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073

National Provider Identifier

NPI Number:
1902564925
Certification Date:
2021-12-07

Authorized Person:

Name:
FAITH GASKINS
Role:
DIRECTOR OF CREDENTIALING
Phone:

Taxonomy:

Selected Taxonomy:
1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000009451 ANDREW B BROWN DDS MS ACTIVE 2022-01-10 2027-12-31 - 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073

Documents

Name Date
ANNUAL REPORT 2025-02-06
ANNUAL REPORT 2024-02-13
ANNUAL REPORT 2023-02-03
ANNUAL REPORT 2022-04-11
Florida Limited Liability 2021-11-02

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Date of last update: 01 Aug 2025

Sources: Florida Department of State