| Entity Name: | MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF FT. MYERS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Mar 2011 (14 years ago) |
| Document Number: | P11000028062 |
| FEI/EIN Number | 45-1261244 |
| Mail Address: | 6240 Lake Osprey Dr., Sarasota, FL, 34240, US |
| Address: | 13195 Metro Park, Ft. Myers, FL, 33966, US |
| ZIP code: | 33966 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962794602 | 2011-05-13 | 2014-08-01 | 13195 SW 134TH ST FL 2, MIAMI, FL, 331864461, US | 13195 METRO PKWY, FORT MYERS, FL, 339664810, US | |||||||||||||||||||||||||
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| Phone | +1 305-274-2499 |
| Fax | 3052749312 |
| Phone | +1 239-768-2485 |
Authorized person
| Name | STEPHANIE GOMEZ |
| Role | PROVIDER RELATIONS SPECIALIST |
| Phone | 3052742499 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | No |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | No |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Gallo Donald | Director | 13195 SW 134 STREET, 2ND FLOOR, MIAMI, FL, 33186 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-05-10 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-10 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-26 | 13195 Metro Park, Ft. Myers, FL 33966 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-26 | 13195 Metro Park, Ft. Myers, FL 33966 | No data |
| Name | Date |
|---|---|
| Reg. Agent Change | 2024-05-10 |
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-04-03 |
| ANNUAL REPORT | 2016-03-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
