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PERIO DOCTOR LLC

Company Details

Entity Name: PERIO DOCTOR LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 03 Jul 2023 (2 years ago)
Document Number: L23000315170
FEI/EIN Number 93-2229669
Address: 1312 East Broward Boulevard, Fort Lauderdale, FL 33301
Mail Address: 1312 East Broward Boulevard, Fort Lauderdale, FL 33301
ZIP code: 33301
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1881440105 2024-04-26 2024-04-26 1312 E BROWARD BLVD, FORT LAUDERDALE, FL, 333012136, US 1312 E BROWARD BLVD, FORT LAUDERDALE, FL, 333012136, US

Contacts

Phone +1 786-449-4262

Authorized person

Name DR. VANESSA LYNN MANCUSO
Role OWNER
Phone 7864494262

Taxonomy

Taxonomy Code 1223P0300X - Periodontist
Is Primary Yes

Agent

Name Role Address
Mancuso, Vanessa Lynn Agent Apt 18, Apt 18, Fort Lauderdale, FL 33304

MANAGER

Name Role Address
MANCUSO, VANESSA LYNN, DR. MANAGER 744 NE 14TH AVE, APT 18, FORT LAUDERDALE, FL 33304

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000015512 OASIS PERIO ACTIVE 2024-01-28 2029-12-31 No data 1312 E BROWARD BLVD, FORT LAUDERDALE, FL, 33301

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-05-15 1312 East Broward Boulevard, Fort Lauderdale, FL 33301 No data
CHANGE OF PRINCIPAL ADDRESS 2024-04-09 1312 East Broward Boulevard, Fort Lauderdale, FL 33301 No data
REGISTERED AGENT NAME CHANGED 2024-04-09 Mancuso, Vanessa Lynn No data
REGISTERED AGENT ADDRESS CHANGED 2024-04-09 Apt 18, Apt 18, Fort Lauderdale, FL 33304 No data

Documents

Name Date
ANNUAL REPORT 2024-04-09
Florida Limited Liability 2023-07-03

Date of last update: 09 Feb 2025

Sources: Florida Department of State