| Entity Name: | JACQUELINE MOLINA-WASSERMAN, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 08 Mar 2005 (20 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P05000035220 |
| FEI/EIN Number | 202489825 |
| Address: | 7378 LAKE WORTH RD, LAKE WORTH, FL, 33467 |
| Mail Address: | 7378 LAKE WORTH RD, LAKE WORTH, FL, 33467 |
| ZIP code: | 33467 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306080387 | 2009-04-22 | 2009-04-22 | 7378 LAKE WORTH RD, LAKE WORTH, FL, 334672529, US | 7378 LAKE WORTH RD, LAKE WORTH, FL, 334672529, US | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| Phone | +1 561-968-7050 |
| Fax | 5619687068 |
Authorized person
| Name | JACQUELINE MOLINA WASSERMAN |
| Role | OWNER |
| Phone | 5619687050 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 17422 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 13861 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | 17306 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Patricia Padilla Sheppard | Agent | 21122 Via Ventura, BOCA RATON, FL, 33433 |
| Name | Role | Address |
|---|---|---|
| MOLINA-WASSERMAN JACQUELINE | Director | 7378 LAKE WORTH RD, LAKE WORTH, FL, 33467 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-27 | 21122 Via Ventura, BOCA RATON, FL 33433 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-15 | Patricia Padilla Sheppard | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-01-19 |
| ANNUAL REPORT | 2014-01-10 |
| ANNUAL REPORT | 2013-03-22 |
| ANNUAL REPORT | 2012-03-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
