| Entity Name: | KING BENJAMIN DENTAL PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Aug 2024 (6 months ago) |
| Document Number: | L24000352144 |
| Address: | 18589 SARASOTA RD., FORT MYERS, FL 33967 |
| Mail Address: | 18589 SARASOTA RD., FORT MYERS, FL 33967 |
| ZIP code: | 33967 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366262701 | 2024-10-11 | 2024-10-11 | 18589 SARASOTA RD, FORT MYERS, FL, 339673520, US | 3467 PINE RIDGE RD STE 101, NAPLES, FL, 341093832, US | |||||||||||||||
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| Phone | +1 239-240-5886 |
| Phone | +1 239-251-5045 |
Authorized person
| Name | BRADLY MOURITSEN |
| Role | SOLE MEMBER |
| Phone | 2392515045 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRADLY MOURISTEN | Agent | 18589 SARASOTA RD., FORT MYERS, FL 33967 |
| Name | Role | Address |
|---|---|---|
| MOURITSEN, BRADLY | Authorized Member | 18589 SARASOTA RD., FORT MYERS, FL 33967 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-08-15 |
Date of last update: 07 Feb 2025
Sources: Florida Department of State
