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  5. DRS. CHASOLEN & CHASOLEN, P.A.

DRS. CHASOLEN & CHASOLEN, P.A.

Company Details

Entity Name: DRS. CHASOLEN & CHASOLEN, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 15 Aug 2001 (23 years ago)
Document Number: P01000081522
FEI/EIN Number 651131108
Address: 2033 WOOD STREET STE 125, SARASOTA, FL, 34237
Mail Address: 2033 MAIN STREET STE 600, SARASOTA, FL, 34237
ZIP code: 34237
County: Sarasota
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1841495124 2007-06-18 2020-08-22 2033 WOOD ST, SUITE 125, SARASOTA, FL, 342377900, US 2033 WOOD ST, SUITE 125, SARASOTA, FL, 342377900, US

Contacts
Phone +1 941-957-0073

Authorized person
Name GINGER R CHASOLEN
Role OWNER PARTNER
Phone 9419570073

Taxonomy
Taxonomy Code 1223P0700X - Prosthodontist
License Number DN13735
State FL
Is Primary Yes
Taxonomy Code 1223P0700X - Prosthodontist
License Number DN13718
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DRS. CHASOLEN & CHASOLEN, P.A. SAFE HARBOR 401(K) PLAN 2011 651131108 2012-10-16 DRS. CHASOLEN & CHASOLEN, P.A. 9
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 9419570063
Plan sponsor’s address 2033 WOOD STREET, SUITE 125, SARASOTA, FL, 342377933

Plan administrator’s name and address
Administrator’s EIN 651131108
Plan administrator’s name DRS. CHASOLEN & CHASOLEN, P.A.
Plan administrator’s address 2033 WOOD STREET, SUITE 125, SARASOTA, FL, 342377933
Administrator’s telephone number 9419570063

Signature of
Role Plan administrator
Date 2012-10-16
Name of individual signing HOWARD CHASOLEN DMD
Valid signature Filed with authorized/valid electronic signature
DRS. CHASOLEN & CHASOLEN, P.A. SAFE HARBOR 401(K) PLAN 2011 651131108 2013-01-22 DRS. CHASOLEN & CHASOLEN, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 9419570063
Plan sponsor’s address 2033 WOOD STREET, SUITE 125, SARASOTA, FL, 342377933

Plan administrator’s name and address
Administrator’s EIN 651131108
Plan administrator’s name DRS. CHASOLEN & CHASOLEN, P.A.
Plan administrator’s address 2033 WOOD STREET, SUITE 125, SARASOTA, FL, 342377933
Administrator’s telephone number 9419570063

Signature of
Role Plan administrator
Date 2013-01-22
Name of individual signing HOWARD CHASOLEN DMD
Valid signature Filed with authorized/valid electronic signature
DRS. CHASOLEN & CHASOLEN, P.A. SAFE HARBOR 401(K) PLAN 2010 651131108 2011-10-17 DRS. CHASOLEN & CHASOLEN, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 9419570063
Plan sponsor’s address 2033 WOOD STREET, SUITE 125, SARASOTA, FL, 342377933

Plan administrator’s name and address
Administrator’s EIN 651131108
Plan administrator’s name DRS. CHASOLEN & CHASOLEN, P.A.
Plan administrator’s address 2033 WOOD STREET, SUITE 125, SARASOTA, FL, 342377933
Administrator’s telephone number 9419570063

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing GERMAINE LEVERETTE
Valid signature Filed with authorized/valid electronic signature
DRS. CHASOLEN & CHASOLEN, P.A. SAFE HARBOR 401K PLAN 2009 651131108 2010-10-14 DRS. CHASOLEN & CHASOLEN, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 9419570073
Plan sponsor’s address 2033 WOOD STREET SUITE 125, SARASOTA, FL, 34237

Plan administrator’s name and address
Administrator’s EIN 651131108
Plan administrator’s name DRS. CHASOLEN & CHASOLEN, P.A.
Plan administrator’s address 2033 WOOD STREET SUITE 125, SARASOTA, FL, 34237
Administrator’s telephone number 9419570073

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing DR. HOWARD CHASOLEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BARTLETT CHARLES J Agent ICARD MERRILL CULLIS TIMM FUREN & GINBURG, SARASOTA, FL, 34237

Treasurer

Name Role Address
CHASOLEN HOWARD M Treasurer 2033 WOOD STREET STE 125, SARASOTA, FL, 34237

Director

Name Role Address
CHASOLEN HOWARD M Director 2033 WOOD STREET STE 125, SARASOTA, FL, 34237
CHASOLEN GINGER Director 2033 WOOD STREET STE 125, SARASOTA, FL, 34237

President

Name Role Address
CHASOLEN GINGER President 2033 WOOD STREET STE 125, SARASOTA, FL, 34237

Secretary

Name Role Address
CHASOLEN GINGER Secretary 2033 WOOD STREET STE 125, SARASOTA, FL, 34237

Vice President

Name Role Address
CHASOLEN HOWARD M Vice President 2033 WOOD STREET STE 125, SARASOTA, FL, 34237

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2012-09-28 No data No data

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Related by address

No related companies by address

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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