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  5. W. ROGER LONG, D.D.S., P.A.

W. ROGER LONG, D.D.S., P.A.

Company Details

Entity Name: W. ROGER LONG, D.D.S., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 01 Mar 2001 (24 years ago)
Document Number: P01000023143
FEI/EIN Number 651076951
Address: 1511 SOUTH 25TH STREET, FT PIERCE, FL, 34947, US
Mail Address: 1511 SOUTH 25TH STREET, FT PIERCE, FL, 34947, US
ZIP code: 34947
County: St. Lucie
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932602661 2018-03-08 2018-03-08 1511 S 25TH ST, FORT PIERCE, FL, 349474779, US 1511 S 25TH ST, FORT PIERCE, FL, 349474779, US

Contacts
Phone +1 772-464-2943
Fax 7724648801

Authorized person
Name DR. W.ROGER LONG
Role OWNER
Phone 7724642943

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number 9663
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
W. ROGER LONG, D.D.S., P.A. 401(K) PROFIT SHARING PLAN 2023 651076951 2024-09-26 W. ROGER LONG, D.D.S., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, FORT PIERCE, FL, 34947
W. ROGER LONG, D.D.S., P.A. 401(K) PROFIT SHARING PLAN 2022 651076951 2023-09-19 W. ROGER LONG, D.D.S., P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, FORT PIERCE, FL, 34947
W. ROGER LONG, D.D.S., P.A. 401(K) PROFIT SHARING PLAN 2021 651076951 2022-09-01 W. ROGER LONG, D.D.S., P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, FORT PIERCE, FL, 34947
W. ROGER LONG, D.D.S., P.A. 401(K) PROFIT SHARING PLAN 2020 651076951 2021-10-12 W. ROGER LONG, D.D.S., P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, FORT PIERCE, FL, 34947
W. ROGER LONG, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2019 651076951 2020-10-08 W. ROGER LONG, D.D.S., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, SUITE A, FORT PIERCE, FL, 349474779

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-08
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
W. ROGER LONG, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2018 651076951 2019-10-10 W. ROGER LONG, D.D.S., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, SUITE A, FORT PIERCE, FL, 349474779

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-10
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
W. ROGER LONG, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2017 651076951 2018-09-28 W. ROGER LONG, D.D.S., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, SUITE A, FORT PIERCE, FL, 349474779

Signature of
Role Plan administrator
Date 2018-09-28
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-09-28
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
W. ROGER LONG, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2016 651076951 2017-10-14 W. ROGER LONG, D.D.S., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, SUITE A, FORT PIERCE, FL, 349474779

Signature of
Role Plan administrator
Date 2017-10-14
Name of individual signing W ROGER LONG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-14
Name of individual signing W ROGER LONG
Valid signature Filed with authorized/valid electronic signature
W. ROGER LONG, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2015 651076951 2016-10-11 W. ROGER LONG, D.D.S., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, SUITE A, FORT PIERCE, FL, 349474779

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-11
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
W. ROGER LONG, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2014 651076951 2015-10-06 W. ROGER LONG, D.D.S., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621210
Sponsor’s telephone number 7724642943
Plan sponsor’s address 1511 SOUTH 25TH STREET, SUITE A, FORT PIERCE, FL, 349474779

Signature of
Role Plan administrator
Date 2015-10-06
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-06
Name of individual signing W. ROGER LONG
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Moore John III Agent 3240 Cardinal Drive, VERO BEACH, FL, 32963

Director

Name Role Address
LONG W R Director 1511 S 25 STREET, FORT PIERCE, FL, 34947

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G21000153987 SMOOTH SAILING DENTAL ACTIVE 2021-11-17 2026-12-31 No data W. ROGER LONG, DDS, PA, 1511 SOUTH 25TH STREET, FORT PIERCE, FL, 34947

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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