| Entity Name: | FLORIDA CENTER FOR ORAL SURGERY & DENTAL IMPLANTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Jul 2004 (21 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Apr 2018 (7 years ago) |
| Document Number: | P04000108370 |
| FEI/EIN Number | 201435221 |
| Address: | 4953 LE CHALET, BOYNTON BEACH, FL, 33436, US |
| Mail Address: | 4953 LE CHALET, BOYNTON BEACH, FL, 33436, US |
| ZIP code: | 33436 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295150845 | 2014-02-19 | 2014-02-19 | 12651 W SUNRISE BLVD, SUITE 304, SUNRISE, FL, 333230906, US | 12651 W SUNRISE BLVD, SUITE 304, SUNRISE, FL, 333230906, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-845-0098 |
| Fax | 9548450280 |
Authorized person
| Name | DR. DAMONE E SMITH |
| Role | PRESIDENT |
| Phone | 9548450098 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | DN16488 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 690057701 |
| State | FL |
| Issuer | MEDICAID |
| Number | 690057796 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH DAMONE E | Agent | 4953 LE CHALET, BOYNTON BEACH, FL, 33436 |
| Name | Role | Address |
|---|---|---|
| SMITH DAMONE E | President | 10792 EL CABALLO CT., DEL RAY BEACH, FL, 33446 |
| Name | Role | Address |
|---|---|---|
| SMITH DAMONE E | Secretary | 10792 EL CABALLO CT., DEL RAY BEACH, FL, 33446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-09 | 4953 LE CHALET, # 1, BOYNTON BEACH, FL 33436 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-09 | 4953 LE CHALET, # 1, BOYNTON BEACH, FL 33436 | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-09 | 4953 LE CHALET, # 1, BOYNTON BEACH, FL 33436 | No data |
| REINSTATEMENT | 2018-04-13 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-13 | SMITH, DAMONE E | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REINSTATEMENT | 2012-07-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REINSTATEMENT | 2010-06-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-03-31 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-02-09 |
| ANNUAL REPORT | 2019-04-30 |
| REINSTATEMENT | 2018-04-13 |
| ANNUAL REPORT | 2014-01-12 |
| ANNUAL REPORT | 2013-03-29 |
| REINSTATEMENT | 2012-07-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
