| Entity Name: | GD FL FOREST PARK, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Jan 2023 (2 years ago) |
| Document Number: | L23000033660 |
| FEI/EIN Number | 92-1966063 |
| Address: | 703 NW 62ND AVE, STE 490, MIAMI, FL, 33126, US |
| Mail Address: | 703 NW 62ND AVE, STE 490, MIAMI, FL, 33126, US |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487356234 | 2023-03-17 | 2023-03-17 | 2620 JENKS AVE, PANAMA CITY, FL, 324054311, US | 2620 JENKS AVE, PANAMA CITY, FL, 324054311, US | |||||||||||||
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| Phone | +1 850-785-8586 |
Authorized person
| Name | CHAD HENDRICKS |
| Role | CREDENTIALING |
| Phone | 6128590444 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CAPITOL CORPORATE SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MOLINA ANTONIO | Member | 703 NW 62ND AVE, STE 490, MIAMI, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-20 | 703 NW 62ND AVE, STE 490, MIAMI, FL 33126 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-20 | 703 NW 62ND AVE, STE 490, MIAMI, FL 33126 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| Florida Limited Liability | 2023-01-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
