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 |
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 | |||||||||||||
|
Phone | +1 786-449-4262 |
Authorized person
Name | DR. VANESSA LYNN MANCUSO |
Role | OWNER |
Phone | 7864494262 |
Taxonomy
Taxonomy Code | 1223P0300X - Periodontist |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
Mancuso, Vanessa Lynn | Agent | Apt 18, Apt 18, Fort Lauderdale, FL 33304 |
Name | Role | Address |
---|---|---|
MANCUSO, VANESSA LYNN, DR. | MANAGER | 744 NE 14TH AVE, APT 18, FORT LAUDERDALE, FL 33304 |
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 |
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 |
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