| Entity Name: | JAX BEACHES DENTAL CARE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Nov 2021 (3 years ago) |
| Document Number: | L21000506650 |
| FEI/EIN Number | 47-1057781 |
| Address: | 802 SOUTH 3RD ST., NEPTUNE BEACH, FL 32266 |
| Mail Address: | 802 SOUTH 3RD ST., NEPTUNE BEACH, FL 32266 |
| ZIP code: | 32266 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275238305 | 2023-03-30 | 2023-03-30 | 802 3RD STREET, NEPTUNE BEACH, FL, 32266, US | 802 3RD STREET, NEPTUNE BEACH, FL, 32266, US | |||||||||||||||
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| Phone | +1 904-247-0111 |
| Fax | 9042473320 |
Authorized person
| Name | MICHELLE D HUCKE |
| Role | DENTIST/OWNER |
| Phone | 9042470111 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAX BEACHES DENTAL CARE PLLC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 873870413 | 2024-05-05 | JAX BEACHES DENTAL CARE PLLC | 14 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 471637791 |
| Plan administrator’s name | ERISA FIDUCIARY SERVICES, INC. |
| Plan administrator’s address | 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
| Administrator’s telephone number | 6312490500 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-05 |
| Name of individual signing | ERISA FIDUCIARY SERVICES |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 9042470111 |
| Plan sponsor’s address | 802 SOUTH 3RD ST, NEPTUNE BEACH, FL, 322665018 |
Plan administrator’s name and address
| Administrator’s EIN | 471637791 |
| Plan administrator’s name | ERISA FIDUCIARY SERVICES, INC. |
| Plan administrator’s address | 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
| Administrator’s telephone number | 6312490500 |
Signature of
| Role | Plan administrator |
| Date | 2023-04-08 |
| Name of individual signing | ERISA FIDUCIARY SERVICES |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| LUDWIG HULSEY, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| HUCKE, MICHELLE D | Authorized Member | 802 SOUTH 3RD ST., NEPTUNE BEACH, FL 32266 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-04-15 |
| Florida Limited Liability | 2021-11-29 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
