| Entity Name: | LAKE MARY SMILES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Jan 2022 (3 years ago) |
| Document Number: | L22000036950 |
| FEI/EIN Number | 87-4510661 |
| Mail Address: | 3221 CONWAY RD, STE D, ORLANDO, FL, 32812, US |
| Address: | 570 RINEHART RD, LAKE MARY, FL, 32746, US |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588314686 | 2022-03-24 | 2022-03-24 | 3221 CONWAY RD STE D, ORLANDO, FL, 328127354, US | 570 RINEHART RD STE 110, LAKE MARY, FL, 327464801, US | |||||||||||||||||||||
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| Phone | +1 407-432-6224 |
| Phone | +1 407-333-7393 |
Authorized person
| Name | PETER KELLY |
| Role | OWNER |
| Phone | 4073337393 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | DM19430 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROBINSON MATTHEW | Agent | 3221 CONWAY RD, ORLANDO, FL, 32812 |
| Name | Role | Address |
|---|---|---|
| KELLY PETER | Managing Member | 3221 CONWAY RD STE D, ORLANDO, FL, 32812 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000060362 | LAKE MARY COSMETIC & IMPLANT DENTISTRY | ACTIVE | 2022-05-13 | 2027-12-31 | No data | 3221 CONWAY RD STE D, ORLANDO, FL, 32812 |
| G22000045651 | IMPLANT DENTISTRY | ACTIVE | 2022-04-11 | 2027-12-31 | No data | 3221 CONWAY RD STE D, ORLANDO, FL, 32812 |
| G22000045650 | LAKE MARY COSMETIC | ACTIVE | 2022-04-11 | 2027-12-31 | No data | 3221 CONWAY RD STE D, ORLANDO, FL, 32812 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-24 | 570 RINEHART RD, STE 110, LAKE MARY, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-02-24 |
| Florida Limited Liability | 2022-01-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
