| Entity Name: | LEGACY DENTAL STUDIO, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Apr 2024 (9 months ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 Jun 2024 (7 months ago) |
| Document Number: | L24000168577 |
| Address: | 50 ORIGINS MAIN STREET, SUITE 200, WATERSOUND, FL 32461 |
| Mail Address: | 50 ORIGINS MAIN STREET, SUITE 200, WATERSOUND, FL 32461 |
| ZIP code: | 32461 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851118475 | 2024-09-24 | 2024-09-24 | 50 ORIGINS MAIN STREET, SUITE 200, INLET BEACH, FL, 32461, US | 50 ORIGINS MAIN STREET, SUITE 200, INLET BEACH, FL, 32461, US | |||||||||||||
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| Phone | +1 850-818-9006 |
Authorized person
| Name | REESE HARRISON |
| Role | MANAGER/PROVIDER |
| Phone | 8508189006 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LEGACY DENTAL STUDIO 401(K) PLAN | 2022 | 270777828 | 2023-07-20 | LEGACY DENTAL STUDIO | 10 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| HARRISON, F. REESE, JR. | Agent | 306 CANNONBALL LANE, INLET BEACH, FL 32461 |
| Name | Role | Address |
|---|---|---|
| HARRISON, F. REESE, JR. | Manager | 50 ORIGINS MAIN STREET, SUITE 200, WATERSOUND, FL 32461 |
| DREIER, BRANDON | Manager | 50 ORIGINS MAIN STREET, SUITE 200, WATERSOUND, FL 32461 |
| YORK, BENNETT V | Manager | 112 SHEFFIELD LOOP STE D, HATTIESBURG, MS 39402 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-06-21 | No data | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-06-21 |
| Florida Limited Liability | 2024-04-09 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
