| Entity Name: | INTERCOASTAL DENTAL PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 May 2022 (3 years ago) |
| Document Number: | L22000237147 |
| FEI/EIN Number | 88-2676735 |
| Address: | 11940 US 1 # 245, PALM BEACH GARDENS, FL, 33408, US |
| Mail Address: | 11940 US 1 # 245, PALM BEACH GARDENS, FL, 33408, US |
| ZIP code: | 33408 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205563004 | 2022-08-02 | 2022-08-02 | 104 SANTA BARBARA WAY, PALM BEACH GARDENS, FL, 334104319, US | 11940 US 1 STE 245, PALM BEACH GARDENS, FL, 334082832, US | |||||||||||||
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| Phone | +1 626-264-0182 |
Authorized person
| Name | DR. ALEXANDRE EIAN GAETA |
| Role | PRESIDENT |
| Phone | 6262640182 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GAETA ALEXANDRE | Agent | 104 SANTA BARBARA WAY, PALM BEACH GARDENS, FL, 33410 |
| Name | Role | Address |
|---|---|---|
| GAETA ALEXANDRE | Authorized Member | 104 SANTA BARBARA WAY, PALM BEACH GARDENS, FL, 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-29 | 11940 US 1 # 245, PALM BEACH GARDENS, FL 33408 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-29 | 11940 US 1 # 245, PALM BEACH GARDENS, FL 33408 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-02-02 |
| Florida Limited Liability | 2022-05-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
