| Entity Name: | BOCA RATON DENTAL SPECIALISTS PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Nov 2022 (2 years ago) |
| Document Number: | L22000504546 |
| FEI/EIN Number | 88-4353935 |
| Address: | 19615 STATE ROAD 7, SUITE 34, BOCA RATON, FL 33498 |
| Mail Address: | 19615 STATE ROAD 7, SUITE 34, BOCA RATON, FL 33498 |
| ZIP code: | 33498 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477265056 | 2022-12-15 | 2023-06-30 | 19615 STATE ROAD 7 STE 34, BOCA RATON, FL, 334984700, US | 19615 STATE ROAD 7 STE 34, BOCA RATON, FL, 334984700, US | |||||||||||||
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| Phone | +1 561-270-6070 |
Authorized person
| Name | JULIE ROLLINS |
| Role | OFFICE MANAGER |
| Phone | 5612706070 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PUCKETT, JUSTIN | Agent | 2403 LACY LANE, CARROLLTON, FL 75006 |
| Name | Role | Address |
|---|---|---|
| SHELLING, ROBERT | Manager | 19615 STATE ROAD 7, SUITE 34, BOCA RATON, FL 33498 |
| Name | Role | Address |
|---|---|---|
| DeButy, John Alexander | Tax Analyst | 2403 Lacy Lane, Carrollton, TX 75006 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000151079 | BOCA RATON ORAL SURGERY SPECIALISTS | ACTIVE | 2022-12-08 | 2027-12-31 | No data | 19615 STATE ROAD 7, SUITE 34, BOCA RATON, FL, 33498 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-01-19 |
| Florida Limited Liability | 2022-11-30 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
