| Entity Name: | BROWN DENTISTRY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Nov 2021 (3 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 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902564925 | 2021-12-07 | 2021-12-07 | 2217 KINGSLEY AVE, ORANGE PARK, FL, 320735115, US | 2217 KINGSLEY AVE, ORANGE PARK, FL, 320735115, US | |||||||||||||
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| Phone | +1 904-272-1165 |
Authorized person
| Name | FAITH GASKINS |
| Role | DIRECTOR OF CREDENTIALING |
| Phone | 9728693789 |
Taxonomy
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PUCKETT JUSTIN | Agent | 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| BROWN ANDREW | Manager | 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| 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 | No data | 2217 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-04-11 |
| Florida Limited Liability | 2021-11-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
