| Entity Name: | SAGE DENTAL KIDS OF NEW TAMPA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 28 Jun 2023 (2 years ago) |
| Document Number: | L23000310256 |
| FEI/EIN Number | 99-0954323 |
| Address: | 6600 CONGRESS AVE STE 150, BOCA RATON, FL 33487 |
| Mail Address: | 6600 CONGRESS AVE STE 150, BOCA RATON, FL 33487 |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992567309 | 2024-01-30 | 2024-03-13 | PO BOX 931622, ATLANTA, GA, 311931622, US | 10317 CROSS CREEK BLVD STE B, TAMPA, FL, 336472845, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 813-973-3100 |
Authorized person
| Name | DR. CINDY ROARK |
| Role | SVP & CHIEF CLINICAL OFFICER |
| Phone | 5619999650 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 S PINE ISLAND RD, PLANTATION, FL 33324 |
| Name | Role | Address |
|---|---|---|
| Roark, Cindy | President | 6600 CONGRESS AVE STE 150, BOCA RATON, FL 33487 |
| Name | Role |
|---|---|
| SAGE DENTAL GROUP OF FLORIDA, PLLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000078173 | SAGE DENTAL | ACTIVE | 2023-06-29 | 2028-12-31 | No data | 6600 CONGRESS AVE, SUITE 150, BOCA RATON, FL, 33487 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| Florida Limited Liability | 2023-06-28 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
