| Entity Name: | DENTAL IMPLANT AND FACIAL SURGERY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Dec 2021 (3 years ago) |
| Document Number: | L21000526840 |
| FEI/EIN Number | 87-4034594 |
| Address: | 2600 EAST COMMERCIAL BLVD., SUITE 200, FORT LAUDERDALE, FL 33308 |
| Mail Address: | 2600 EAST COMMERCIAL BLVD., SUITE 200, FORT LAUDERDALE, FL 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528712189 | 2022-02-11 | 2022-02-11 | 2600 EAST COMMERCIAL BLVD, SUITE 200, FORT LAUDERDALE, FL, 33308, US | 2600 EAST COMMERCIAL BLVD, SUITE 200, FORT LAUDERDALE, FL, 33308, US | |||||||||||||||||||
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| Phone | +1 954-566-0300 |
| Fax | 9545669066 |
Authorized person
| Name | DR. MICHEL MATOUK |
| Role | OWNER |
| Phone | 9545660300 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| Is Primary | Yes |
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENTAL IMPLANT AND FACIAL SURGERY RETIREMENT PLAN & TRUST | 2022 | 874034594 | 2023-10-04 | DENTAL IMPLANT AND FACIAL SURGERY, PLLC | 16 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| MATOUK, MICHEL | Agent | 2600 EAST COMMERCIAL BLVD., SUITE 200, FORT LAUDERDALE, FL 33308 |
| Name | Role |
|---|---|
| CARLO GUEVARA, M.D., D.D.S., P.A. | Authorized Member |
| MICHEL MATOUK, MD, DDS, PA. | Authorized Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-29 |
| Florida Limited Liability | 2021-12-14 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
