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  5. JEFFREY V. MOFFETT, D.M.D., P.A.

JEFFREY V. MOFFETT, D.M.D., P.A.

Company Details

Entity Name: JEFFREY V. MOFFETT, D.M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 14 Jan 2005 (20 years ago)
Document Number: P05000007887
FEI/EIN Number 202162169
Address: 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579
Mail Address: 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579
ZIP code: 33579
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1033363197 2008-11-14 2008-11-14 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187, US 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187, US

Contacts
Phone +1 813-677-3331
Fax 8136773336

Authorized person
Name DR. JEFFREY VICTOR MOFFETT
Role PRESIDENT
Phone 8136773331

Taxonomy
Taxonomy Code 1223S0112X - Oral and Maxillofacial Surgery (Dentist)
License Number DN15450
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JEFFREY V. MOFFETT 401(K) PLAN 2023 202162169 2024-05-21 JEFFREY V. MOFFETT, D.M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2024-05-21
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2022 202162169 2023-03-22 JEFFREY V. MOFFETT, D.M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2023-03-21
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2021 202162169 2022-07-22 JEFFREY V. MOFFETT, D.M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2022-07-22
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2020 202162169 2021-03-30 JEFFREY V. MOFFETT, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2021-03-30
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2019 202162169 2020-03-16 JEFFREY V. MOFFETT, D.M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2020-03-16
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2018 202162169 2019-01-29 JEFFREY V. MOFFETT, D.M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2019-01-29
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2017 202162169 2018-03-01 JEFFREY V. MOFFETT, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2018-03-01
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2016 202162169 2017-07-05 JEFFREY V. MOFFETT, D.M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2017-07-05
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2015 202162169 2016-05-25 JEFFREY V. MOFFETT, D.M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DR, RIVERVIEW, FL, 335797187

Signature of
Role Plan administrator
Date 2016-05-25
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature
JEFFREY V. MOFFETT 401(K) PLAN 2014 202162169 2015-10-02 JEFFREY V. MOFFETT, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 8136773331
Plan sponsor’s address 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579

Signature of
Role Plan administrator
Date 2015-10-02
Name of individual signing JEFFREY MOFFETT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MOFFETT JEFFREY V Agent 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579

President

Name Role Address
MOFFETT JEFFREY V President 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579

Director

Name Role Address
CASTELLANOS MOFFETT ALI G Director 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2009-04-09 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL 33579 No data
CHANGE OF MAILING ADDRESS 2009-04-09 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL 33579 No data
REGISTERED AGENT ADDRESS CHANGED 2009-04-09 13136 VAIL RIDGE DRIVE, RIVERVIEW, FL 33579 No data

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-02-09
ANNUAL REPORT 2022-06-06
ANNUAL REPORT 2021-03-12
ANNUAL REPORT 2020-07-30
ANNUAL REPORT 2019-04-05
ANNUAL REPORT 2018-06-28
ANNUAL REPORT 2017-04-30
ANNUAL REPORT 2016-03-09
ANNUAL REPORT 2015-05-03

Related by officers

MOFFETT JEFFREY V

MOFFETT HOLDINGS, LLC AFDIC MOFFETT, P.A.

CASTELLANOS MOFFETT ALI G

MOFFETT HOLDINGS, LLC

Related by address

13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579

MOFFETT HOLDINGS, LLC

13136 VAIL RIDGE DRIVE, RIVERVIEW, FL, 33579

MOFFETT HOLDINGS, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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