| Entity Name: | TDN ORTHO LAKEWOOD RANCH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 May 2023 (2 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 22 Jun 2023 (2 years ago) |
| Document Number: | L23000256710 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 1 N. DALE MABRY HIGHWAY, SUITE 605, TAMPA, FL, 33609, US |
| Mail Address: | 1 N. DALE MABRY HIGHWAY, SUITE 605, TAMPA, FL, 33609, US |
| ZIP code: | 33609 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104504877 | 2023-07-11 | 2023-07-11 | 1 N DALE MABRY HWY STE 605, TAMPA, FL, 33609, US | 6286 LAKE OSPREY DR, LAKEWOOD RANCH, FL, 342408425, US | |||||||||||||||||||
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| Phone | +1 813-692-2224 |
| Fax | 8136922224 |
| Phone | +1 941-907-8898 |
| Fax | 9419072244 |
Authorized person
| Name | ROBERT L DEMINT |
| Role | CREDENTIALING COORDINATOR |
| Phone | 8136922224 |
Taxonomy
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHRISTINA C. NETHERO, ESQ. | Agent | 101 EAST KENNEDY BOULEVARD, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| TIMOTHY MUSCARO, DDS | Manager | 1 N. DALE MABRY HIGHWAY, SUITE 605, TAMPA, FL, 33609 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000076976 | VARONE ORTHODONTICS OF LAKEWOOD RANCH | ACTIVE | 2023-06-27 | 2028-12-31 | No data | 6286 LAKE OSPREY DRIVE, LAKEWOOD RANCH, FL, 34240 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2023-06-22 | TDN ORTHO LAKEWOOD RANCH, PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| LC Name Change | 2023-06-22 |
| Florida Limited Liability | 2023-05-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
