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  5. ISLAND COAST DENTISTRY INC

ISLAND COAST DENTISTRY INC

Company Details

Entity Name: ISLAND COAST DENTISTRY INC
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 07 Oct 2010 (14 years ago)
Document Number: P10000082363
FEI/EIN Number 273646423
Address: 1044 CASTELLO DRIVE, 110, NAPLES, FL, 34103
Mail Address: 9585 Everglades Drive, Naples, FL, 34120, US
ZIP code: 34103
County: Collier
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1376844951 2010-11-12 2010-11-12 20570 GROVELINE CT, ESTERO, FL, 33928, US 1044 CASTELLO DR, 110, NAPLES, FL, 34103, US

Contacts
Phone +1 239-261-5566

Authorized person
Name DR. JEFFREY ROBERT SKUPNY
Role PRESIDENT
Phone 3522463177

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number 18097
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ISLAND COAST DENTISTRY 401(K) PLAN 2022 273646423 2023-08-23 ISLAND COAST DENTISTRY, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2023-08-23
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2021 273646423 2022-12-02 ISLAND COAST DENTISTRY, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2022-12-02
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2020 273646423 2021-09-20 ISLAND COAST DENTISTRY, INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2021-09-19
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2019 273646423 2020-09-29 ISLAND COAST DENTISTRY, INC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2020-09-29
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2018 273646423 2019-10-01 ISLAND COAST DENTISTRY, INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2019-09-30
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2017 273646423 2018-05-30 ISLAND COAST DENTISTRY, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2018-05-29
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2016 273646423 2017-05-02 ISLAND COAST DENTISTRY, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2017-05-01
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature
ISLAND COAST DENTISTRY 401(K) PLAN 2015 273646423 2016-04-12 ISLAND COAST DENTISTRY, INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 2392615566
Plan sponsor’s address 1044 CASTELLO DRIVE, SUITE 110, NAPLES, FL, 34103

Signature of
Role Plan administrator
Date 2016-04-12
Name of individual signing JEFFREY SKUPNY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SKUPNY JEFFREY Agent 9585 Everglades Drive, Naples, FL, 34120

President

Name Role Address
SKUPNY JEFFREY President 9585 Everglades Drive, Naples, FL, 34120

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000121086 JEFFREY SKUPNY DMD ACTIVE 2024-09-27 2029-12-31 No data 1044 CASTELLO DRIVE #110, NAPLES, FL, 34103
G10000103766 JEFFREY SKUPNY DMD EXPIRED 2010-11-12 2015-12-31 No data 20570 GROVELINE CT., ESTERO, FL, 33928

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2022-01-30 1044 CASTELLO DRIVE, 110, NAPLES, FL 34103 No data
REGISTERED AGENT ADDRESS CHANGED 2022-01-30 9585 Everglades Drive, Naples, FL 34120 No data
CHANGE OF PRINCIPAL ADDRESS 2012-01-17 1044 CASTELLO DRIVE, 110, NAPLES, FL 34103 No data

Documents

Name Date
ANNUAL REPORT 2024-02-23
ANNUAL REPORT 2023-02-03
ANNUAL REPORT 2022-01-30
ANNUAL REPORT 2021-03-06
ANNUAL REPORT 2020-02-07
ANNUAL REPORT 2019-02-22
ANNUAL REPORT 2018-03-28
ANNUAL REPORT 2017-01-25
ANNUAL REPORT 2016-01-31
ANNUAL REPORT 2015-01-12

Related by officers

SKUPNY JEFFREY

JEFFREY SKUPNY DMD P.A.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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