Entity Name: | HERON BAY DENTAL ASSOCIATES, P.A. |
Jurisdiction: | FLORIDA |
Filing Type: | Domestic Profit |
Status: | Active |
Date Filed: | 23 Mar 2000 (25 years ago) |
Document Number: | P00000029612 |
FEI/EIN Number | 651013029 |
Address: | 5960 CORAL RIDGE DRIVE, CORAL SPRINGS, FL, 33076 |
Mail Address: | 5960 CORAL RIDGE DRIVE, CORAL SPRINGS, FL, 33076 |
ZIP code: | 33076 |
County: | Broward |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1487872230 | 2007-04-24 | 2020-08-22 | 5960 CORAL RIDGE DR, CORAL SPRINGS, FL, 330763302, US | 5960 CORAL RIDGE DR, CORAL SPRINGS, FL, 330763302, US | |||||||||||||||||||
|
Phone | +1 954-255-5550 |
Fax | 9547558276 |
Authorized person
Name | DR. KEITH MARLOWE FRIEFELD |
Role | PRESIDENT |
Phone | 9542555550 |
Taxonomy
Taxonomy Code | 1223G0001X - General Practice Dentistry |
License Number | DN11976 |
State | FL |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
FRIEFELD SHELDON | Agent | 7533 HAWKS LANDING DRIVE, WEST PALM BEACH, FL, 33412 |
Name | Role | Address |
---|---|---|
FRIEFELD KEITH M | Director | 16843 Pavilion Way, Delray Beach, FL, 33446 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State