| Entity Name: | INDIAN TRACE DENTAL ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Jun 2003 (22 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Mar 2011 (14 years ago) |
| Document Number: | P03000066503 |
| FEI/EIN Number | 571171801 |
| Address: | 46 INDIAN TRACE, WESTON, FL, 33326 |
| Mail Address: | 46 INDIAN TRACE, WESTON, FL, 33326 |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780266734 | 2021-04-28 | 2021-04-28 | 46 INDIAN TRCE, WESTON, FL, 333264551, US | 46 INDIAN TRCE, WESTON, FL, 333264551, US | |||||||||||||||||||
|
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| Phone | +1 954-217-9200 |
| Fax | 9542179500 |
Authorized person
| Name | MARTHA VALENCIA |
| Role | OFFICE MANAGER |
| Phone | 9542179200 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1093899171 |
| Name | Role | Address |
|---|---|---|
| VILLA RODOLFO | Agent | 46 INDIAN TRACE, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| VILLA RODOLFO | Director | 46 INDIAN TRACE, WESTON, FL, 33326 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2011-03-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-22 | 46 INDIAN TRACE, WESTON, FL 33326 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-22 | 46 INDIAN TRACE, WESTON, FL 33326 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-22 | 46 INDIAN TRACE, WESTON, FL 33326 | No data |
| CANCEL ADM DISS/REV | 2008-10-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2007-08-20 | VILLA, RODOLFO | No data |
| CANCEL ADM DISS/REV | 2006-11-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-10 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-15 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-27 |
| ANNUAL REPORT | 2016-01-19 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
