| Entity Name: | ALKHADRA DDS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Jan 2008 (17 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P08000007633 |
| FEI/EIN Number | 261779980 |
| Address: | 4800 N.E. 20TH TERR., STE 301, FT. LAUDERDALE, FL, 33308 |
| Mail Address: | 4800 N.E. 20TH TERR., STE 301, FT. LAUDERDALE, FL, 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194050690 | 2009-10-16 | 2010-06-29 | 4800 NE 20TH TER STE 301, FORT LAUDERDALE, FL, 333084510, US | 4800 NE 20TH TER STE 301, FORT LAUDERDALE, FL, 333084510, US | |||||||||||||||||||||||||
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| Phone | +1 954-727-9865 |
| Fax | 9547279904 |
Authorized person
| Name | ENAS ALKHADRA |
| Role | OWNER |
| Phone | 5612120715 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN16650 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075773000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALHADRA ENAS | Agent | 84 VIA POINCIANA LN, BOCA RATON, FL, 33487 |
| Name | Role | Address |
|---|---|---|
| ALKHADRA ENAS | President | 84 VIA POINCIANA LN, BOCA RATON, FL, 33487 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000057801 | DENTALIA | EXPIRED | 2010-06-22 | 2015-12-31 | No data | 84 VIA POINCIANA LN, BOCA RATON, FL, 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-07-06 | 4800 N.E. 20TH TERR., STE 301, FT. LAUDERDALE, FL 33308 | No data |
| CHANGE OF MAILING ADDRESS | 2010-07-06 | 4800 N.E. 20TH TERR., STE 301, FT. LAUDERDALE, FL 33308 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-03-11 | 84 VIA POINCIANA LN, BOCA RATON, FL 33487 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000166917 | LAPSED | 1000000519131 | PALM BEACH | 2013-07-31 | 2024-02-07 | $ 415.36 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-03-17 |
| ADDRESS CHANGE | 2010-07-06 |
| ANNUAL REPORT | 2010-02-18 |
| ANNUAL REPORT | 2009-03-11 |
| Domestic Profit | 2008-01-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
