| Entity Name: | MY DENTIST OF WEST LAKE WORTH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Aug 2024 (6 months ago) |
| Document Number: | L24000355832 |
| Address: | 951 YAMATO ROAD, 106, BOCA RATON, FL, 33431 |
| Mail Address: | 951 YAMATO ROAD, 106, BOCA RATON, FL, 33431 |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285468629 | 2024-08-28 | 2024-08-28 | 8487 LAKE WORTH RD, SUITE 100, WELLINGTON, FL, 33467, US | 8487 LAKE WORTH RD, SUITE 100, WELLINGTON, FL, 33467, US | |||||||||||||||
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| Phone | +1 561-275-5042 |
| Fax | 5612573883 |
Authorized person
| Name | JORDAN TOMALTY |
| Role | CEO |
| Phone | 5616339676 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TOMALTY JORDAN | Agent | 951 YAMATO ROAD, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| TOMALTY JORDAN | Manager | 951 YAMATO ROAD, BOCA RATON, FL, 33431 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-08-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
