| Entity Name: | FLORIDA HEALTHY SMILES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Oct 1989 (35 years ago) |
| Document Number: | L23388 |
| FEI/EIN Number | 650149711 |
| Address: | 4208 WEST 16TH AVENUE, HIALEAH, FL, 33012, US |
| Mail Address: | 4208 WEST 16TH AVENUE, HIALEAH, FL, 33012, US |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942526884 | 2010-04-16 | 2010-04-16 | 555 BILTMORE WAY STE 105, CORAL GABLES, FL, 331345757, US | 555 BILTMORE WAY STE 105, CORAL GABLES, FL, 331345757, US | |||||||||||||||||||||||
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| Phone | +1 305-569-9966 |
Authorized person
| Name | MS. ROSA MARIA SOLER |
| Role | PRESIDENT / DENTIST |
| Phone | 3055699966 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 11884 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 073085800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLORENTINO GUSTAVO | Agent | 4208 WEST 16TH AVENUE #286, HIALEAH, FL, 33012 |
| Name | Role | Address |
|---|---|---|
| FLORENTINO GUSTAVO | President | 4208 WEST 16TH AVENUE #286, HIALEAH, FL, 33012 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000003328 | HIALEAH FAMILY DENTISTRY INC | EXPIRED | 2012-01-10 | 2017-12-31 | No data | 8560 NW 169 TERR, MIAMI LAKES, FL, 33016 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| AMENDMENT | 2015-06-15 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2007-10-05 | FLORIDA HEALTHY SMILES, INC. | No data |
| NAME CHANGE AMENDMENT | 1994-12-23 | HIALEAH FAMILY DENTISTRY, INC. | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
