| Entity Name: | COBBLESTONE FAMILY DENTAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Apr 2022 (3 years ago) |
| Document Number: | L22000144811 |
| FEI/EIN Number | 88-1660655 |
| Address: | 9089 PINTURA WAY, BOCA RATON, FL, 33496, US |
| Mail Address: | 9089 PINTURA WAY, BOCA RATON, FL, 33496, US |
| ZIP code: | 33496 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508596099 | 2022-06-16 | 2022-06-20 | 14938 PINES BLVD, PEMBROKE PINES, FL, 330271213, US | 14938 PINES BLVD, PEMBROKE PINES, FL, 330271213, US | |||||||||||||||||
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| Phone | +1 954-433-2099 |
Authorized person
| Name | JORDAN TOMALTY |
| Role | OWNER |
| Phone | 5616339676 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DENTAL |
| Number | NA |
| Name | Role | Address |
|---|---|---|
| GALVAL MESSICK, PLLC | Agent | 951 YAMATO ROAD, SUITE 250, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| TOMALTY JORDAN SDMD | Manager | 9089 PINTURA WAY, BOCA RATON, FL, 33496 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| ANNUAL REPORT | 2023-01-27 |
| Florida Limited Liability | 2022-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
