| Entity Name: | MARY R. ISAACS, D.M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 May 2005 (20 years ago) |
| Document Number: | P05000066119 |
| FEI/EIN Number | 202928699 |
| Address: | 5965 RED BUG LAKE RD - STE 233, WINTER SPRINGS, FL, 32708 |
| Mail Address: | 5965 RED BUG LAKE RD - STE 233, WINTER SPRINGS, FL, 32708 |
| ZIP code: | 32708 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811092893 | 2006-09-14 | 2020-08-22 | 5965 RED BUG LAKE RD, SUITE 233, WINTER SPRINGS, FL, 327085080, US | 5965 RED BUG LAKE RD, SUITE 233, WINTER SPRINGS, FL, 327085080, US | |||||||||||||||||||||||||||
|
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| Phone | +1 407-696-5210 |
| Fax | 4076966488 |
Authorized person
| Name | DR. MARY ROSE ISAACS |
| Role | PRESIDENT |
| Phone | 4076965210 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN 13097 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS/BLUE SHIELD |
| Number | 69975 |
| Issuer | UNITED CONCORDIA |
| Number | 642592 |
| Name | Role | Address |
|---|---|---|
| Isaacs Mary D | Agent | 5965 Red Bug Lake Road, Winter Spring, FL, 32708 |
| Name | Role | Address |
|---|---|---|
| ISAACS MARY R | President | 5965 RED BUG LAKE RD - STE 233, WINTER SPRINGS, FL, 32708 |
| Name | Role | Address |
|---|---|---|
| ISAACS MARY R | Secretary | 5965 RED BUG LAKE RD - STE 233, WINTER SPRINGS, FL, 32708 |
| Name | Role | Address |
|---|---|---|
| ISAACS MARY R | Treasurer | 5965 RED BUG LAKE RD - STE 233, WINTER SPRINGS, FL, 32708 |
| Name | Role | Address |
|---|---|---|
| ISAACS MARY R | Director | 5965 RED BUG LAKE RD - STE 233, WINTER SPRINGS, FL, 32708 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-01 | Isaacs, Mary D | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-01 | 5965 Red Bug Lake Road, 233, Winter Spring, FL 32708 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-03-31 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-05-17 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-03-18 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
