| Entity Name: | GD FL CSDC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 Apr 2024 (10 months ago) |
| Document Number: | L24000151991 |
| Address: | 5803 NW 151ST ST., STE 201, MIAMI LAKES, FL 33014 |
| Mail Address: | 5803 NW 151ST ST., STE 201, MIAMI LAKES, FL 33014 |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366294936 | 2024-04-04 | 2024-05-15 | 1700 N UNIVERSITY DR STE 110, CORAL SPRINGS, FL, 330718970, US | 1700 N UNIVERSITY DR STE 110, CORAL SPRINGS, FL, 330718970, US | |||||||||||||||||
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| Phone | +1 954-344-8800 |
Authorized person
| Name | CHAD HENDRICKS |
| Role | CREDENTIALING |
| Phone | 6128590444 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| Is Primary | No |
| Name | Role |
|---|---|
| CAPITOL CORPORATE SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MOLINA, ANTONIO | Authorized Member | 5803 NW 151ST ST., STE 201, MIAMI LAKES, FL 33014 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-04-02 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
