| Entity Name: | MOUNT DORA DENTAL & DENTURES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 Apr 2006 (19 years ago) |
| Date of dissolution: | 29 Nov 2016 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 29 Nov 2016 (8 years ago) |
| Document Number: | P06000055523 |
| FEI/EIN Number | 204724076 |
| Address: | 2781 W OLD HWY 441, STE 24A, MOUNT DORAL, FL, 32757 |
| Mail Address: | 2781 W OLD HWY 441, STE 24A, MOUNT DORAL, FL, 32757 |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033372958 | 2008-07-10 | 2011-02-22 | 2781 W OLD HIGHWAY 441, #24A, MOUNT DORA, FL, 32757, US | 2781 W OLD HIGHWAY 441, #24A, MOUNT DORA, FL, 32757, US | |||||||||||||||||||||||||||
|
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| Phone | +1 352-385-1971 |
| Fax | 3257292239 |
| Fax | 3527292239 |
Authorized person
| Name | DR. SOOK JA KIM |
| Role | OWNER |
| Phone | 3523851971 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 14970 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002879200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KIM SOOK | Agent | 2781 W OLD HWY 441, MT.DORA, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| KIM SOOK | President | 2781 W OLD HWY 441, MOUNT DORAL, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| Kim Joong s | Part | 2781 W OLD HWY 441, MOUNT DORAL, FL, 32757 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08163900083 | AFFORDABLE DENTAL CARE | EXPIRED | 2008-06-10 | 2013-12-31 | No data | 2781 WEST OLD HIGHWAY 441, STE 24A, MOUNT DORA, FL, 32757 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-11-29 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-02-07 | KIM, SOOK | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-07 | 2781 W OLD HWY 441, SUITE 24-A, MT.DORA, FL 32757 | No data |
| AMENDMENT AND NAME CHANGE | 2009-08-06 | MOUNT DORA DENTAL & DENTURES, INC. | No data |
| AMENDMENT | 2008-11-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-02-27 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-02-07 |
| ANNUAL REPORT | 2012-01-23 |
| ANNUAL REPORT | 2011-02-02 |
| ANNUAL REPORT | 2010-01-07 |
| Amendment and Name Change | 2009-08-06 |
| ANNUAL REPORT | 2009-02-01 |
| Amendment | 2008-11-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
