| Entity Name: | PERIODONTAL ASSOCIATES OF TAMPA BAY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 May 2011 (14 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 25 Jul 2011 (14 years ago) |
| Document Number: | P11000048099 |
| FEI/EIN Number | 452371331 |
| Address: | 4444 E. Fletcher Ave., Ste A, TAMPA, FL, 33613, US |
| Mail Address: | 4444 E. Fletcher Ave., Ste. A, TAMPA, FL, 33613, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053606178 | 2011-06-16 | 2011-06-16 | 5208 E FOWLER AVE STE F, TEMPLE TERRACE, FL, 336172152, US | 5208 E FOWLER AVE STE F, TEMPLE TERRACE, FL, 336172152, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 813-988-1103 |
| Fax | 8139851524 |
Authorized person
| Name | DR. BRIAN TODD VANAELST |
| Role | PERIODONTIST |
| Phone | 8139881103 |
Taxonomy
| Taxonomy Code | 1223P0300X - Periodontist |
| License Number | DN16867 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VANAELST BRIAN | Agent | 4444 E. Fletcher Ave., Ste A, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| VANAELST BRIAN | Director | 4444 E. Fletcher Ave., Ste A, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| VANAELST BRIAN | President | 4444 E. Fletcher Ave., Ste A, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| VANAELST BRIAN | Secretary | 4444 E. Fletcher Ave., Ste A, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| VANAELST BRIAN | Treasurer | 4444 E. Fletcher Ave., Ste A, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-06 | 4444 E. Fletcher Ave., Ste A, TAMPA, FL 33613 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-06 | 4444 E. Fletcher Ave., Ste A, TAMPA, FL 33613 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-06 | 4444 E. Fletcher Ave., Ste A, TAMPA, FL 33613 | No data |
| AMENDMENT | 2011-07-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-04-11 |
| ANNUAL REPORT | 2020-01-06 |
| ANNUAL REPORT | 2019-03-02 |
| ANNUAL REPORT | 2018-01-02 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-16 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
