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  5. ERIC R. CLAUSSEN, D.M.D., P.A.

ERIC R. CLAUSSEN, D.M.D., P.A.

Company Details

Entity Name: ERIC R. CLAUSSEN, D.M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 09 Jun 2009 (16 years ago)
Last Event: AMENDMENT
Event Date Filed: 06 Jun 2018 (7 years ago)
Document Number: P09000050457
FEI/EIN Number 270340107
Address: 2624 JENKS AVE., PANAMA CITY, FL, 32405, US
Mail Address: 2624 JENKS AVE., PANAMA CITY, FL, 32405, US
ZIP code: 32405
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790087138 2010-11-17 2012-06-29 2624 JENKS AVE, PANAMA CITY, FL, 324054311, US 2624 JENKS AVE, PANAMA CITY, FL, 324054311, US

Contacts
Phone +1 850-215-0798

Authorized person
Name DR. ERIC RICHARD CLAUSSEN
Role PRESIDENT
Phone 4074084880

Taxonomy
Taxonomy Code 1223S0112X - Oral and Maxillofacial Surgery (Dentist)
License Number D17080
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ERIC R. CLAUSSEN, D.M.D., P.A. CASH BALANCE PLAN 2023 270340107 2024-09-18 ERIC R. CLAUSSEN, D.M.D., P.A. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2024-09-18
Name of individual signing ERIC R CLAUSSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-18
Name of individual signing ERIC R CLAUSSEN
Valid signature Filed with authorized/valid electronic signature
ERIC R. CLAUSSEN, D.M.D., P.A. 401K PLAN 2022 270340107 2024-02-05 ERIC R. CLAUSSEN, D.M.D., P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. CASH BALANCE PLAN 2022 270340107 2023-09-20 ERIC R. CLAUSSEN, D.M.D., P.A. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2023-09-20
Name of individual signing LONI FAAS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-20
Name of individual signing LONI FAAS
Valid signature Filed with authorized/valid electronic signature
ERIC R. CLAUSSEN, D.M.D., P.A. CASH BALANCE PENSION PLAN 2021 270340107 2022-10-17 ERIC R. CLAUSSEN, D.M.D., P.A. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. 401K PLAN 2021 270340107 2022-10-17 ERIC R. CLAUSSEN, D.M.D., P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. 401K PLAN 2020 270340107 2021-10-07 ERIC R. CLAUSSEN, D.M.D., P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. CASH BALANCE PENSION PLAN 2020 270340107 2021-10-07 ERIC R. CLAUSSEN, D.M.D., P.A. 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. 401K PLAN 2019 270340107 2020-10-14 ERIC R. CLAUSSEN, D.M.D., P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. CASH BALANCE PENSION PLAN 2019 270340107 2020-10-14 ERIC R. CLAUSSEN, D.M.D., P.A. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405
ERIC R. CLAUSSEN, D.M.D., P.A. CASH BALANCE PENSION PLAN 2018 270340107 2019-10-09 ERIC R. CLAUSSEN, D.M.D., P.A. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 8502150798
Plan sponsor’s address 2624 JENKS AVENUE, PANAMA CITY, FL, 32405

Agent

Name Role Address
CLAUSSEN ERIC R Agent 2624 JENKS AVE., PANAMA CITY, FL, 32405

President

Name Role Address
CLAUSSEN ERIC R President 2624 JENKS AVE., PANAMA CITY, FL, 32405

CE

Name Role Address
CLAUSSEN ERIC R CE 2624 JENKS AVE., PANAMA CITY, FL, 32405

Vice President

Name Role Address
CLAUSSEN MEGHANN F Vice President 2624 JENKS AVE., PANAMA CITY, FL, 32405

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000059094 ORAL SURGERY AND DENTAL IMPLANT CENTER OF PANAMA CITY EXPIRED 2016-06-15 2021-12-31 No data 2624 JENKS, PANAMA CITY, FL, 32405

Events

Event Type Filed Date Value Description
AMENDMENT 2018-06-06 No data No data
CHANGE OF PRINCIPAL ADDRESS 2012-01-22 2624 JENKS AVE., PANAMA CITY, FL 32405 No data
CHANGE OF MAILING ADDRESS 2012-01-22 2624 JENKS AVE., PANAMA CITY, FL 32405 No data
REGISTERED AGENT ADDRESS CHANGED 2012-01-22 2624 JENKS AVE., PANAMA CITY, FL 32405 No data

Documents

Name Date
ANNUAL REPORT 2024-02-07
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-01-28
ANNUAL REPORT 2021-01-27
ANNUAL REPORT 2020-03-10
ANNUAL REPORT 2019-02-07
Amendment 2018-06-06
ANNUAL REPORT 2018-02-12
ANNUAL REPORT 2017-01-12
ANNUAL REPORT 2016-03-04

Related by officers

CLAUSSEN ERIC R

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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