| Entity Name: | LAKE BUENA VISTA DENTAL, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Feb 2000 (25 years ago) |
| Document Number: | P00000012495 |
| FEI/EIN Number | 650978730 |
| Mail Address: | 6240 LAKE OSPREY DR., SARASOTA, FL, 34240 |
| Address: | 12131 S. APOPKA-VINELAND RD, ORLANDO, FL, 32836 |
| ZIP code: | 32836 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366566903 | 2007-03-19 | 2020-08-22 | 12131 S. APOPKA-VINELAND ROAD, ORLANDO, FL, 32801, US | 12131 S. APOPKA-VINELAND ROAD, ORLANDO, FL, 32801, US | |||||||||||||
|
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| Phone | +1 407-239-8883 |
Authorized person
| Name | MIKE COLE |
| Role | INSURANCE DIRECTOR |
| Phone | 7277261611 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| GALLO DONALD | Director | 6240 LAKE OSPREY DR., SARASOTA, FL, 34240 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000026290 | ADVANCED DENTAL CARE | EXPIRED | 2018-02-22 | 2023-12-31 | No data | 6240 LAKE OSPREY DRIVE, SARASOTA, FL, 34240 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
