| Entity Name: | WATERSIDE DERMATOLOGY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Apr 2023 (2 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 11 Jul 2023 (2 years ago) |
| Document Number: | L23000193634 |
| FEI/EIN Number | 92-3850966 |
| Address: | 300 Riverside Dr E #2200, Bradenton, FL 34208 |
| Mail Address: | 300 Riverside Dr E #2200, Bradenton, FL 34208 |
| ZIP code: | 34208 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639856297 | 2023-07-05 | 2023-07-05 | 5953 17TH AVE W, BRADENTON, FL, 342097836, US | 5953 17TH AVE W, BRADENTON, FL, 342097836, US | |||||||||||||
|
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| Phone | +1 941-794-5246 |
Authorized person
| Name | ERFON EKHLASSI |
| Role | OWNER AND PHYSICIAN |
| Phone | 9417945246 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| EKHLASSI, ERFON | Agent | 700 S HARBOUR ISLAND BOULEVARD,, #731, TAMPA, FL 33602 |
| Name | Role | Address |
|---|---|---|
| AUNG-DIN, DAVID | Manager | 700 S HARBOUR ISLAND BLVD #731, TAMPA, FL 33602 |
| EKHLASSI, ERFON | Manager | 700 S HARBOUR ISLAND BLVD #731, TAMPA, FL 33602 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-23 | 300 Riverside Dr E #2200, Bradenton, FL 34208 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-23 | 300 Riverside Dr E #2200, Bradenton, FL 34208 | No data |
| LC AMENDMENT | 2023-07-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| LC Amendment | 2023-07-11 |
| Florida Limited Liability | 2023-04-18 |
Date of last update: 10 Jan 2025
Sources: Florida Department of State
