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  5. BARTON R. BLUMBERG, D.M.D., P.A.

BARTON R. BLUMBERG, D.M.D., P.A.

Company Details

Entity Name: BARTON R. BLUMBERG, D.M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 Mar 2007 (18 years ago)
Document Number: P07000039232
FEI/EIN Number 680222480
Address: 7590 SE 12 Circle, Ocala, FL, 34480, US
Mail Address: 7590 SE 12 Circle, Ocala, FL, 34480, US
ZIP code: 34480
County: Marion
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1346443355 2007-06-07 2020-08-22 1503 BUENOS AIRES BLVD., STE. 190, THE VILLAGES, FL, 32159, US 1503 BUENOS AIRES BLVD., STE. 190, THE VILLAGES, FL, 32159, US

Contacts
Phone +1 352-430-2100
Fax 3524301297

Authorized person
Name DR. BARTON R BLUMBERG
Role PRESIDENT
Phone 3524302100

Taxonomy
Taxonomy Code 261QS0112X - Oral and Maxillofacial Surgery Clinic/Center
License Number DN 9030
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2017 680222480 2018-10-11 BARTON R. BLUMBERG, D.M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Signature of
Role Plan administrator
Date 2018-10-11
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2016 680222480 2017-06-28 BARTON R. BLUMBERG, D.M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Signature of
Role Plan administrator
Date 2017-06-28
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2015 680222480 2016-07-07 BARTON R. BLUMBERG, D.M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Signature of
Role Plan administrator
Date 2016-07-07
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2014 680222480 2015-08-31 BARTON R. BLUMBERG, D.M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Signature of
Role Plan administrator
Date 2015-08-31
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2013 680222480 2014-08-06 BARTON R. BLUMBERG, D.M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Signature of
Role Plan administrator
Date 2014-08-06
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2012 680222480 2013-07-10 BARTON R. BLUMBERG, D.M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Signature of
Role Plan administrator
Date 2013-07-10
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2011 680222480 2012-09-27 BARTON R. BLUMBERG, D.M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Plan administrator’s name and address
Administrator’s EIN 680222480
Plan administrator’s name BARTON R. BLUMBERG, D.M.D., P.A.
Plan administrator’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822
Administrator’s telephone number 3524302100

Signature of
Role Plan administrator
Date 2012-09-27
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2010 680222480 2011-07-25 BARTON R. BLUMBERG, D.M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Plan administrator’s name and address
Administrator’s EIN 680222480
Plan administrator’s name BARTON R. BLUMBERG, D.M.D., P.A.
Plan administrator’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822
Administrator’s telephone number 3524302100

Signature of
Role Plan administrator
Date 2011-07-25
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
BARTON R. BLUMBERG, D.M.D., P.A. PROFIT SHARING 401K PLAN 2009 680222480 2010-09-13 BARTON R. BLUMBERG, D.M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-07-01
Business code 621112
Sponsor’s telephone number 3524302100
Plan sponsor’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822

Plan administrator’s name and address
Administrator’s EIN 680222480
Plan administrator’s name BARTON R. BLUMBERG, D.M.D., P.A.
Plan administrator’s address 1503 BUENOS AIRES BLVD., SUITE 190, THE VILLAGES, FL, 321596822
Administrator’s telephone number 3524302100

Signature of
Role Plan administrator
Date 2010-09-13
Name of individual signing BARTON R. BLUMBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BLUMBERG BARTON RDMD Agent 7590 SE 12 Circle, Ocala, FL, 34480

Director

Name Role Address
BLUMBERG BARTON R Director 7590 SE 12 Circle, Ocala, FL, 34480

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-01-27 7590 SE 12 Circle, Ocala, FL 34480 No data
CHANGE OF MAILING ADDRESS 2022-01-27 7590 SE 12 Circle, Ocala, FL 34480 No data
REGISTERED AGENT ADDRESS CHANGED 2022-01-27 7590 SE 12 Circle, Ocala, FL 34480 No data
REGISTERED AGENT NAME CHANGED 2020-01-16 BLUMBERG, BARTON R, DMD No data

Documents

Name Date
ANNUAL REPORT 2025-01-20
ANNUAL REPORT 2024-01-03
ANNUAL REPORT 2023-03-01
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-01-11
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-01-07
ANNUAL REPORT 2018-01-18
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-01-05

Related by officers

BLUMBERG BARTON R

BLUMBERG FAMILY PROPERTIES, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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