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  5. ANDREW L SKIGEN, DMD, PA

ANDREW L SKIGEN, DMD, PA

Company Details

Entity Name: ANDREW L SKIGEN, DMD, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 04 Feb 2000 (25 years ago)
Last Event: AMENDMENT AND NAME CHANGE
Event Date Filed: 02 Nov 2018 (6 years ago)
Document Number: P00000014214
FEI/EIN Number 593628724
Address: 7711 BAYMEADOWS RD EAST,, JACKSONVILLE, FL, 32256, US
Mail Address: 7711 BAYMEADOWS RD EAST,, JACKSONVILLE, FL, 32256, US
ZIP code: 32256
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1164814596 2015-02-23 2015-09-03 8708 PERIMETER PARK BLVD, SUITE #1, JACKSONVILLE, FL, 322161107, US 8708 PERIMETER PARK BLVD, SUITE #1, JACKSONVILLE, FL, 322166354, US

Contacts
Phone +1 904-565-1505
Fax 9045651506

Authorized person
Name DR. ANDREW L SKIGEN
Role SURGEON
Phone 9045651505

Taxonomy
Taxonomy Code 204E00000X - Oral & Maxillofacial Surgery (D.M.D.)
License Number DN14048
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANDREW L. SKIGEN, DMD PA 401K PLAN 2023 593628724 2024-07-18 ANDREW L. SKIGEN, DMD PA 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 7711 BAYMEADOWS ROAD EAST, SUITE 7, JACKSONVILLE, FL, 32256

Signature of
Role Plan administrator
Date 2024-07-18
Name of individual signing SHIRLEY HORNER
Valid signature Filed with authorized/valid electronic signature
ANDREW L. SKIGEN, DMD PA 401K PLAN 2022 593628724 2023-06-23 ANDREW L. SKIGEN, DMD PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 7711 BAYMEADOWS ROAD EAST, SUITE 7, JACKSONVILLE, FL, 32256

Signature of
Role Plan administrator
Date 2023-06-23
Name of individual signing NICK RICE
Valid signature Filed with authorized/valid electronic signature
ANDREW L. SKIGEN, DMD PA 401K PLAN 2021 593628724 2022-06-08 ANDREW L. SKIGEN, DMD PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 7711 BAYMEADOWS ROAD EAST, SUITE 7, JACKSONVILLE, FL, 32256

Signature of
Role Plan administrator
Date 2022-06-08
Name of individual signing ANDREW SKIGEN
Valid signature Filed with authorized/valid electronic signature
ANDREW L. SKIGEN, DMD PA 401K PLAN 2020 593628724 2021-07-13 ANDREW L. SKIGEN, DMD PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 7711 BAYMEADOWS ROAD EAST, SUITE 7, JACKSONVILLE, FL, 32256

Signature of
Role Plan administrator
Date 2021-07-13
Name of individual signing ANDREW SKIGEN
Valid signature Filed with authorized/valid electronic signature
ANDREW L. SKIGEN, DMD PA 401K PLAN 2019 593628724 2021-08-16 ANDREW L. SKIGEN, DMD PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 7711 BAYMEADOWS ROAD EAST, SUITE 7, JACKSONVILLE, FL, 32256

Signature of
Role Plan administrator
Date 2021-08-16
Name of individual signing ANDREW SKIGEN
Valid signature Filed with authorized/valid electronic signature
ANDREW L. SKIGEN, DMD PA 401K PLAN 2019 593628724 2021-07-13 ANDREW L. SKIGEN, DMD PA 7
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 7711 BAYMEADOWS ROAD EAST, SUITE 7, JACKSONVILLE, FL, 32256

Signature of
Role Plan administrator
Date 2021-07-13
Name of individual signing ANDREW SKIGEN
Valid signature Filed with authorized/valid electronic signature
ANDREW L SKIGEN DMD PA 401 K PROFIT SHARING PLAN TRUST 2011 593628724 2012-11-13 ANDREW L SKIGEN DMD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 8708 PERIMETER PARK BLVD # A, JACKSONVILLE, FL, 322166354

Plan administrator’s name and address
Administrator’s EIN 593628724
Plan administrator’s name ANDREW L SKIGEN DMD PA
Plan administrator’s address 8708 PERIMETER PARK BLVD # A, JACKSONVILLE, FL, 322166354
Administrator’s telephone number 9045651505

Signature of
Role Plan administrator
Date 2012-11-13
Name of individual signing ANDREW L SKIGEN DMD PA
Valid signature Filed with authorized/valid electronic signature
ANDREW L SKIGEN DMD PA 401 K PROFIT SHARING PLAN TRUST 2011 593628724 2012-11-13 ANDREW L SKIGEN DMD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 8708 PERIMETER PARK BLVD # A, JACKSONVILLE, FL, 322166354

Plan administrator’s name and address
Administrator’s EIN 593628724
Plan administrator’s name ANDREW L SKIGEN DMD PA
Plan administrator’s address 8708 PERIMETER PARK BLVD # A, JACKSONVILLE, FL, 322166354
Administrator’s telephone number 9045651505

Signature of
Role Plan administrator
Date 2012-11-13
Name of individual signing ANDREW L SKIGEN DMD PA
Valid signature Filed with authorized/valid electronic signature
ANDREW L SKIGEN DMD PA 401 K PROFIT SHARING PLAN TRUST 2010 593628724 2011-07-05 ANDREW L SKIGEN DMD PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 9045651505
Plan sponsor’s address 8708 PERIMETER PARK BLVD A, JACKSONVILLE, FL, 32216

Plan administrator’s name and address
Administrator’s EIN 593628724
Plan administrator’s name ANDREW L SKIGEN DMD PA
Plan administrator’s address 8708 PERIMETER PARK BLVD A, JACKSONVILLE, FL, 32216
Administrator’s telephone number 9045651505

Signature of
Role Plan administrator
Date 2011-07-05
Name of individual signing ANDREW L SKIGEN DMD PA
Valid signature Filed with authorized/valid electronic signature
ANDREW L SKIGEN DMD PA 2009 593628724 2010-06-16 ANDREW L SKIGEN DMD PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 339116
Sponsor’s telephone number 9045651505
Plan sponsor’s address 8708 PERIMETER PARK BLVD A, JACKSONVILLE, FL, 32216

Plan administrator’s name and address
Administrator’s EIN 593628724
Plan administrator’s name ANDREW L SKIGEN DMD PA
Plan administrator’s address 8708 PERIMETER PARK BLVD A, JACKSONVILLE, FL, 32216
Administrator’s telephone number 9045651505

Signature of
Role Plan administrator
Date 2010-06-16
Name of individual signing ANDREW L SKIGEN DMD PA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BRACEWELL, JR. K. MEsq. Agent ROGERS TOWERS, P.A., JACKSONVILLE, FL, 32207

Director

Name Role Address
SKIGEN ANDREW L Director 7711 BAYMEADOWS RD EAST,, JACKSONVILLE, FL, 32256

Events

Event Type Filed Date Value Description
AMENDMENT AND NAME CHANGE 2018-11-02 ANDREW L SKIGEN, DMD, PA No data
REGISTERED AGENT NAME CHANGED 2018-04-18 BRACEWELL, JR., K. MAC, Esq. No data
REGISTERED AGENT ADDRESS CHANGED 2018-04-18 ROGERS TOWERS, P.A., 1301 RIVERPLACE BLVD., STE 1500, JACKSONVILLE, FL 32207 No data
CHANGE OF MAILING ADDRESS 2017-10-30 7711 BAYMEADOWS RD EAST,, SUITE #7, JACKSONVILLE, FL 32256 No data
CHANGE OF PRINCIPAL ADDRESS 2017-09-28 7711 BAYMEADOWS RD EAST,, SUITE #7, JACKSONVILLE, FL 32256 No data
NAME CHANGE AMENDMENT 2017-04-26 SKIGEN & HENLEY, P.A. No data

Documents

Name Date
ANNUAL REPORT 2024-03-29
ANNUAL REPORT 2023-03-22
ANNUAL REPORT 2022-04-27
ANNUAL REPORT 2021-01-28
ANNUAL REPORT 2020-01-21
ANNUAL REPORT 2019-02-19
Amendment and Name Change 2018-11-02
ANNUAL REPORT 2018-04-18
Name Change 2017-04-26
ANNUAL REPORT 2017-01-19

Related by officers

SKIGEN ANDREW L

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BRACEWELL, JR. K. MEsq.

FLIP SKY PURPLE, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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