| Entity Name: | SAGE DENTAL OF JACKSONVILLE SOUTHSIDE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Sep 2023 (a year ago) |
| Document Number: | L23000429625 |
| FEI/EIN Number | 93-2986182 |
| 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 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710766001 | 2023-09-26 | 2023-09-26 | PO BOX 931622, ATLANTA, GA, 311931622, US | 4540 SOUTHSIDE BLVD STE 801, JACKSONVILLE, FL, 322165490, US | |||||||||||||
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| Phone | +1 561-999-9650 |
Authorized person
| Name | CINDY ROARK |
| Role | SVP & CHIEF CLINICAL OFFICER |
| Phone | 5619999650 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| SAGE DENTAL GROUP OF FLORIDA, PLLC | Manager |
| Name | Role | Address |
|---|---|---|
| Roark, Cindy | President | 6600 CONGRESS AVE STE 150, BOCA RATON, FL 33487 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000120561 | SAGE DENTAL | ACTIVE | 2023-09-28 | 2028-12-31 | No data | 6600 CONGRESS AVE, SUITE 150, BOCA RATON, FL, 33487 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| Florida Limited Liability | 2023-09-14 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
