| Entity Name: | SAGE DENTAL OF DAYTONA AT BEACH STREET, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Oct 2022 (2 years ago) |
| Document Number: | L22000451639 |
| FEI/EIN Number | 92-0790565 |
| Address: | 6600 Congress Avenue, BOCA RATON, FL, 33487, US |
| Mail Address: | 6600 Congress Avenue, BOCA RATON, FL, 33487, US |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780394718 | 2022-11-30 | 2023-05-19 | 6600 CONGRESS AVE STE 150, BOCA RATON, FL, 334871213, US | 208 S BEACH ST, DAYTONA BEACH, FL, 321144404, US | |||||||||||||||
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| Phone | +1 561-999-9650 |
| Phone | +1 470-990-8723 |
Authorized person
| Name | CINDY ROARK |
| Role | SVP & CHIEF CLINICAL OFFICER |
| Phone | 5619999650 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Name | Role |
|---|---|
| SAGE DENTAL GROUP OF FLORIDA, PLLC | Manager |
| Name | Role | Address |
|---|---|---|
| Roark Cindy | President | 6600 Congress Avenue, BOCA RATON, FL, 33487 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000134272 | SAGE DENTAL | ACTIVE | 2022-10-27 | 2027-12-31 | No data | 951 BROKEN SOUND PARKWAY, SUITE 250, BOCA RATON, FL, 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-06 | 6600 Congress Avenue, Suite 150, BOCA RATON, FL 33487 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-06 | 6600 Congress Avenue, Suite 150, BOCA RATON, FL 33487 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-02-06 |
| Florida Limited Liability | 2022-10-20 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
