| Entity Name: | PINES PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Nov 2022 (2 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 12 Jan 2023 (2 years ago) |
| Document Number: | L22000483365 |
| FEI/EIN Number | 88-4298808 |
| Address: | 17767 SW 2ND STREET, PEMBROKE PINES, FL 33029 |
| Mail Address: | 17767 SW 2ND STREET, PEMBROKE PINES, FL 33029 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710696612 | 2022-11-18 | 2022-11-18 | 17767 SW 2ND ST, PEMBROKE PINES, FL, 330293924, US | 17767 SW 2ND ST, PEMBROKE PINES, FL, 330293924, US | |||||||||||||||||||
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| Phone | +1 561-336-6560 |
| Fax | 5613366560 |
Authorized person
| Name | DR. MITCHELL MILLER |
| Role | OWNER |
| Phone | 5613366560 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | No |
| Name | Role |
|---|---|
| BLALOCK WALTERS, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| MILLER, MITCHELL, DDS | Manager | 17767 SW 2ND STREET, PEMBROKE PINES, FL 33029 |
| KALLIS, NICKOLAOS, DMD | Manager | 17767 SW 2ND STREET, PEMBROKE PINES, FL 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2023-01-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-12 | 17767 SW 2ND STREET, PEMBROKE PINES, FL 33029 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-12 | 17767 SW 2ND STREET, PEMBROKE PINES, FL 33029 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-07 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-06 |
| LC Amendment | 2023-01-12 |
| Florida Limited Liability | 2022-11-14 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
