| Entity Name: | GALLERIA DENTISTRY LEGACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Dec 2022 (2 years ago) |
| Document Number: | L22000523825 |
| FEI/EIN Number | 92-1359804 |
| Address: | 4440 AURORA ST., NAPLES, FL 34119 |
| Mail Address: | 4440 AURORA ST., NAPLES, FL 34119 |
| ZIP code: | 34119 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508977281 | 2006-08-31 | 2023-03-22 | 9140 GALLERIA COURT, NAPLES, FL, 34109, US | 9140 GALLERIA COURT, NAPLES, FL, 34109, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-592-5112 |
| Fax | 2395920254 |
Authorized person
| Name | DR. CHELSEA ANN YANDA BENZA |
| Role | OWNER/DENTIST |
| Phone | 2395925112 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN9062 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1316322134 |
| State | FL |
| Issuer | NPI |
| Number | 1467837278 |
| State | FL |
| Issuer | NPI |
| Number | 1083725758 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GALLERIA DENTISTRY LEGACY LLC 401(K) PROFIT SHARING PLAN | 2023 | 921359804 | 2024-07-22 | GALLERIA DENTISTRY LEGACY LLC | 25 | |||||||||||||
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| Name | Role |
|---|---|
| CHESTNUT BUSINESS SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| ANTHONY JOHN BENZA, DMD | Manager | 4440 AURORA ST., NAPLES, FL 34119 |
| CHELSEA ANN YANDA BENZA, DMD | Manager | 4440 AURORA ST., NAPLES, FL 34119 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000138013 | GALLERIA DENTISTRY | ACTIVE | 2023-11-10 | 2028-12-31 | No data | 4440 AURORA STREET, NAPLES, FL, 34119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-12-03 | 311 PARK PLACE BOULEVARD, SUITE 300, CLEARWATER, FL 33759 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-02-03 |
| Florida Limited Liability | 2022-12-14 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
