| Entity Name: | PEDIATRIC & ORTHODONTIC DENTAL CENTERS OF BROWARD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 31 Oct 2006 (18 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 05 Dec 2014 (10 years ago) |
| Document Number: | P06000138112 |
| FEI/EIN Number | 205822593 |
| Address: | 7244 West Mcnab Rd, North Lauderdale, FL, 33068, US |
| Mail Address: | 7244 West McNab rd, North Lauderdale, FL, 33068, US |
| ZIP code: | 33068 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902027683 | 2007-05-01 | 2009-03-17 | 8351 W ATLANTIC BLVD, CORAL SPRINGS, FL, 330717454, US | 8351 W ATLANTIC BLVD, CORAL SPRINGS, FL, 330717454, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 954-341-0002 |
Authorized person
| Name | ENRIQUE ACOSTA |
| Role | PEDIATRIC DENTIST |
| Phone | 9543410002 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN17284 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 076110900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 076240700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 076721200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ACOSTA ENRIQUE | Agent | 2645 Douglas Rd., MIAMI, FL, 33133 |
| Name | Role | Address |
|---|---|---|
| ACOSTA ENRIQUE | President | 2645 Douglas Rd., MIAMI, FL, 33133 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-06-03 | 7244 West Mcnab Rd, North Lauderdale, FL 33068 | No data |
| CHANGE OF MAILING ADDRESS | 2024-06-03 | 7244 West Mcnab Rd, North Lauderdale, FL 33068 | No data |
| AMENDMENT | 2014-12-05 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-08 | 2645 Douglas Rd., Suite 703, MIAMI, FL 33133 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| AMENDED ANNUAL REPORT | 2024-06-03 |
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-18 |
| ANNUAL REPORT | 2021-02-21 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
