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  5. TAMPA BAY SMILES, INC.

TAMPA BAY SMILES, INC.

Company Details

Entity Name: TAMPA BAY SMILES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 04 Aug 2004 (21 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 09 Dec 2004 (20 years ago)
Document Number: P04000114011
FEI/EIN Number 201497457
Address: 5438 Land O Lakes Blvd, Land O' Lakes, FL, 34639, US
Mail Address: 1307 Merry Water Drive, Lutz, FL, 33548, US
ZIP code: 34639
County: Pasco
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1609567056 2023-05-17 2023-05-17 1307 MERRY WATER DR, LUTZ, FL, 335484810, US 5438 LAND O LAKES BLVD, LAND O LAKES, FL, 346393413, US

Contacts
Phone +1 813-857-8696
Fax 8139290996
Phone +1 813-929-0996

Authorized person
Name DR. JASON M MOORE
Role PRESIDENT
Phone 8138578696

Taxonomy
Taxonomy Code 122300000X - Dentist
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TAMPA BAY SMILES, INC. 401(K) PLAN 2023 201497457 2024-10-10 TAMPA BAY SMILES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND OLAKES BLVD., LANDO LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2024-10-10
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-10
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2022 201497457 2023-05-12 TAMPA BAY SMILES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND OLAKES BLVD., LAND O LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2023-05-12
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-05-12
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2021 201497457 2022-09-23 TAMPA BAY SMILES, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND O'LAKES BLVD., LAND O LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2022-09-23
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-09-23
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2020 201497457 2021-05-20 TAMPA BAY SMILES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND OLAKES BLVD., LAND OLAKES, FL, 34638

Signature of
Role Plan administrator
Date 2021-05-20
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-05-20
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2019 201497457 2020-08-27 TAMPA BAY SMILES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND O'LAKES BLVD., LAND O LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2020-08-27
Name of individual signing JASON M MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-08-27
Name of individual signing JASON M MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2018 201497457 2019-07-17 TAMPA BAY SMILES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND O LAKES BLVD., LAND O LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-17
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2017 201497457 2018-06-25 TAMPA BAY SMILES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND O'LAKES BLVD., LAND O LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2018-06-25
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-25
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2016 201497457 2017-07-13 TAMPA BAY SMILES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 6759 LAND O'LAKES BLVD., LAND O LAKES, FL, 34638

Signature of
Role Plan administrator
Date 2017-07-13
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-13
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC 401(K) PLAN 2015 201497457 2016-05-27 TAMPA BAY SMILES, INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8139290996
Plan sponsor’s address 36759LAND OLAKES BLVD., LAND OLAKES, FL, 34638

Signature of
Role Plan administrator
Date 2016-05-27
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY SMILES, INC. 401(K) PLAN 2014 201497457 2015-05-04 TAMPA BAY SMILES, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 8138188054
Plan sponsor’s address 8963 RACE TRACK ROAD, TAMPA, FL, 33635

Signature of
Role Plan administrator
Date 2015-05-04
Name of individual signing JASON MOORE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MOORE JASON M Agent 1307 Merry Water Drive, Lutz, FL, 33548

Director

Name Role Address
MOORE JASON M Director 1307 Merry Water Drive, Lutz, FL, 33548

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-02-21 5438 Land O Lakes Blvd, Land O' Lakes, FL 34639 No data
CHANGE OF MAILING ADDRESS 2023-02-21 5438 Land O Lakes Blvd, Land O' Lakes, FL 34639 No data
REGISTERED AGENT ADDRESS CHANGED 2015-01-14 1307 Merry Water Drive, Lutz, FL 33548 No data
NAME CHANGE AMENDMENT 2004-12-09 TAMPA BAY SMILES, INC. No data

Documents

Name Date
ANNUAL REPORT 2024-02-15
ANNUAL REPORT 2023-02-21
ANNUAL REPORT 2022-02-21
ANNUAL REPORT 2021-01-27
ANNUAL REPORT 2020-02-25
ANNUAL REPORT 2019-01-31
ANNUAL REPORT 2018-03-16
ANNUAL REPORT 2017-01-12
ANNUAL REPORT 2016-01-21
ANNUAL REPORT 2015-01-14

Related by officers

MOORE JASON M

J2 MOORE ENTERPRISES, INC RUCKS FARM, LLC C. JACKSON HOLDINGS, LLC SHADY LANE HOLDINGS LLC TIER 1 PERFORMANCE HORSES, LLC JM AERO HOLDINGS LLC LOAD IT TRUCKING LLC 321 LUCKY FEW FL, LLC ALLEGIANCE CONSTRUCTION, INC. JM NAUTICAL HOLDINGS, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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