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  5. ST. JOHNS RIVER DENTAL, PLLC

ST. JOHNS RIVER DENTAL, PLLC

Company Details

Entity Name: ST. JOHNS RIVER DENTAL, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 21 Sep 2022 (2 years ago)
Document Number: L22000412588
FEI/EIN Number 92-0482970
Address: 6200 ST. JOHNS AVENUE, PALATKA, FL 32177
Mail Address: 6200 ST. JOHNS AVENUE, PALATKA, FL 32177
ZIP code: 32177
County: Putnam
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790024248 2013-02-04 2013-02-04 500 S HIGHWAY 19, PALATKA, FL, 321773943, US 500 S HIGHWAY 19, PALATKA, FL, 321773943, US

Contacts
Phone +1 386-325-5467
Fax 3863252635

Authorized person
Name DR. DEREK RAY MORRIS
Role OWNER
Phone 3863255467

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ST. JOHNS RIVER DENTAL 401(K) PLAN 2023 261119882 2024-05-13 ST. JOHNS RIVER DENTAL 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2024-05-13
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-05-13
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2022 261119882 2023-09-14 ST. JOHNS RIVER DENTAL 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2023-09-14
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-14
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2021 261119882 2022-07-28 ST. JOHNS RIVER DENTAL 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-28
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2020 261119882 2021-07-29 ST. JOHNS RIVER DENTAL 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2021-07-29
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-29
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2019 261119882 2020-08-05 ST. JOHNS RIVER DENTAL 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2020-08-05
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-08-05
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2018 261119882 2019-08-28 ST. JOHNS RIVER DENTAL 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2019-08-28
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-08-28
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2017 261119882 2018-08-14 ST. JOHNS RIVER DENTAL 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2018-08-14
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-08-14
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2016 261119882 2017-04-25 ST. JOHNS RIVER DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2017-04-25
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-25
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2015 261119882 2016-07-28 ST. JOHNS RIVER DENTAL 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 6200 ST. JOHNS AVE., PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-28
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS RIVER DENTAL 401(K) PLAN 2014 261119882 2015-06-25 ST. JOHNS RIVER DENTAL 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-08-01
Business code 621210
Sponsor’s telephone number 3863255467
Plan sponsor’s address 500 S. HWY 19, PALATKA, FL, 32177

Signature of
Role Plan administrator
Date 2015-06-25
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-25
Name of individual signing DEREK MORRIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MORRIS, DEREK R Agent 6200 ST. JOHNS AVENUE, PALATKA, FL 32177

Authorized Member

Name Role
DEREK R. MORRIS D.D.S. P.A. Authorized Member
PHILLIP M ROBBINS, DMD, PLLC Authorized Member

Documents

Name Date
ANNUAL REPORT 2024-03-06
ANNUAL REPORT 2023-02-01
Florida Limited Liability 2022-09-21

Related by officers

MORRIS, DEREK R

M&K POOLS PLUS LLC

Related by address

6200 ST. JOHNS AVENUE, PALATKA, FL 32177

DEREK R. MORRIS D.D.S. P.A.

6200 ST. JOHNS AVENUE, PALATKA, FL 32177

DEREK R. MORRIS D.D.S. P.A.

Date of last update: 11 Jan 2025

Sources: Florida Department of State

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