| Entity Name: | MOBILE DENTAL HEAD-START, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Sep 2024 (4 months ago) |
| Document Number: | L24000415715 |
| Address: | 1839 LANE AVENUE SOUTH, SUITE 104, JACKSONVILLE, FL, 32210, US |
| Mail Address: | 1839 LANE AVENUE SOUTH, SUITE 104, JACKSONVILLE, FL, 32210, US |
| ZIP code: | 32210 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356161293 | 2024-10-15 | 2024-10-24 | 1839 LANE AVE S STE 104, JACKSONVILLE, FL, 322101260, US | 1839 LANE AVE S STE 104, JACKSONVILLE, FL, 322101260, US | |||||||||||||
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| Phone | +1 904-300-0126 |
Authorized person
| Name | KENJULA BROWN |
| Role | OWNER |
| Phone | 9043000126 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| GARY JOHNSON'S ACCOUNTING & TAX SERVICE, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| BROWN KENJULA | Manager | 14599 CAMBERWELL LANE NORTH, JACKSONVILLE, FL, 32258 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-09-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
