| Entity Name: | PALM HARBOR DENTAL GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Mar 2023 (2 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 31 May 2023 (2 years ago) |
| Document Number: | L23000094273 |
| FEI/EIN Number | 92-2687892 |
| Address: | 30685 US HWY 19 NORTH, PALM HARBOR, FL, 34684, US |
| Mail Address: | 30685 US HWY 19 NORTH, PALM HARBOR, FL, 34684, US |
| ZIP code: | 34684 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699554238 | 2023-09-25 | 2023-09-25 | 30685 US HIGHWAY 19 N, PALM HARBOR, FL, 346844410, US | 30685 US HIGHWAY 19 N, PALM HARBOR, FL, 346844410, US | |||||||||||||
|
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| Phone | +1 727-249-0460 |
Authorized person
| Name | SHIRLEY BOCAS |
| Role | OFFICE MANAGER |
| Phone | 7272490460 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KAPLAN KAREN | Agent | 11800 30TH COURT NORTH, ST. PETERSBURG, FL, 33716 |
| Name | Role | Address |
|---|---|---|
| ADUSUMILLI DIVVA | Manager | 30685 US HWY 19 NORTH, PALM HARBOR, FL, 34684 |
| PHILOMIN ARVIND | Manager | 30685 US HWY 19 NORTH, PALM HARBOR, FL, 34684 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000116443 | PALM HARBOR DENTAL | ACTIVE | 2023-09-20 | 2028-12-31 | No data | 30685 US HIGHWAY 19 NORTH, PALM HARBOR, FL, 34684 |
| G23000078609 | PALM HARBOR PREMIER DENTAL | ACTIVE | 2023-06-30 | 2028-12-31 | No data | 30685 US HIGHWAY 19 NORTH, PALM HARBOR, FL, 34684 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-10 | 30685 US HWY 19 NORTH, PALM HARBOR, FL 34684 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-10 | 30685 US HWY 19 NORTH, PALM HARBOR, FL 34684 | No data |
| LC AMENDMENT | 2023-05-31 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| LC Amendment | 2023-05-31 |
| Florida Limited Liability | 2023-03-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
