| Entity Name: | BEACHES ORAL AND MAXILLOFACIAL SURGERY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Mar 2024 (a year ago) |
| Document Number: | L24000111996 |
| Address: | 472 JACKSONVILLE DR., JACKSONVILLE BEACH, FL 32250 |
| Mail Address: | 472 JACKSONVILLE DR., JACKSONVILLE BEACH, FL 32250 |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265292346 | 2024-03-19 | 2024-03-19 | 472 JACKSONVILLE DR, JACKSONVILLE BEACH, FL, 322503812, US | 472 JACKSONVILLE DR, JACKSONVILLE BEACH, FL, 322503812, US | |||||||||||||||
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| Phone | +1 904-246-6545 |
| Fax | 9042463718 |
Authorized person
| Name | JOHN LANDIS |
| Role | OWNER |
| Phone | 9042466545 |
Taxonomy
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| Is Primary | Yes |
| Name | Role |
|---|---|
| THE FORDE FIRM, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| LANDI, JOHN F | Authorized Member | 472 JACKSONVILLE DR., JACKSONVILLE BEACH, FL 32250 |
| HARPER, NATHAN M | Authorized Member | 472 JACKSONVILLE DR., JACKSONVILLE BEACH, FL 32250 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-05 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
