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  5. MATE DENTAL ASSOCIATES, INC.

MATE DENTAL ASSOCIATES, INC.

Company Details

Entity Name: MATE DENTAL ASSOCIATES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Nov 2009 (15 years ago)
Last Event: AMENDMENT
Event Date Filed: 09 Jun 2011 (14 years ago)
Document Number: P09000090057
FEI/EIN Number 271220918
Address: 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
Mail Address: 4075 CR 218 WEST, MIDDLEBURG, FL, 32068, US
ZIP code: 32068
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1437280385 2007-03-09 2009-12-22 4075 CR 218 WEST, MIDDLEBURG, FL, 32068, US 4075 CR 218 WEST, MIDDLEBURG, FL, 32068, US

Contacts
Fax 9042820905

Authorized person
Name SHANNON M. MATE
Role OWNER
Phone 9042829371

Taxonomy
Taxonomy Code 122300000X - Dentist
License Number DN13458
State FL
Is Primary Yes
Taxonomy Code 122300000X - Dentist
License Number DN13093
State FL
Is Primary No
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number DH0013458
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GATOR RETIREMENT PLAN & TRUST 2023 271220918 2024-06-07 MATE DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2022 271220918 2023-06-21 MATE DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2022 271220918 2023-06-06 MATE DENTAL ASSOCIATES, INC. 8
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2021 271220918 2022-08-10 MATE DENTAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2020 271220918 2021-05-18 MATE DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2019 271220918 2020-09-08 MATE DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2018 271220918 2019-09-12 MATE DENTAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2017 271220918 2018-07-31 MATE DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068
GATOR RETIREMENT PLAN & TRUST 2016 271220918 2017-08-11 MATE DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068

Signature of
Role Plan administrator
Date 2017-08-11
Name of individual signing SHANNON M. MATE, D.M.D.
Valid signature Filed with authorized/valid electronic signature
GATOR RETIREMENT PLAN & TRUST 2015 271220918 2016-09-13 MATE DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 9042829371
Plan sponsor’s address 4075 CR 218 WEST, MIDDLEBURG, FL, 32068

Signature of
Role Plan administrator
Date 2016-09-13
Name of individual signing SHANNON M. MATE, D.M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MATE SHANNON M Agent 4075 CR 218 WEST, MIDDLEBURG, FL, 32068

President

Name Role Address
MATE SHANNON M President 4075 CR 218 WEST, MIDDLEBURG, FL, 32068

Vice President

Name Role Address
HUAMAN KEVIN A Vice President 4075 CR 218 WEST, MIDDLEBURG, FL, 32068

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2021-03-19 4075 CR 218 WEST, MIDDLEBURG, FL 32068 No data
REGISTERED AGENT ADDRESS CHANGED 2021-03-19 4075 CR 218 WEST, MIDDLEBURG, FL 32068 No data
AMENDMENT 2011-06-09 No data No data
CHANGE OF PRINCIPAL ADDRESS 2011-01-22 4075 CR 218 WEST, MIDDLEBURG, FL 32068 No data

Documents

Name Date
ANNUAL REPORT 2025-01-07
ANNUAL REPORT 2024-01-09
ANNUAL REPORT 2023-01-18
ANNUAL REPORT 2022-01-20
ANNUAL REPORT 2021-03-19
ANNUAL REPORT 2020-01-11
ANNUAL REPORT 2019-01-17
ANNUAL REPORT 2018-02-06
ANNUAL REPORT 2017-03-15
ANNUAL REPORT 2016-01-11

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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