| Entity Name: | JOSSUE ALFONSO DMD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 14 Jun 2011 (14 years ago) |
| Document Number: | P11000055480 |
| FEI/EIN Number | 45-2531760 |
| Address: | 351 NW 42ND AVE, 402, MIAMI, FL 33126 |
| Mail Address: | 351 NW 42ND AVE, 402, MIAMI, FL 33126 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174931208 | 2014-08-01 | 2014-08-01 | 351 NW 42ND AVE, SUITE 402, MIAMI, FL, 331265683, US | 351 NW 42ND AVE, SUITE 402, MIAMI, FL, 331265683, US | |||||||||||||||||||||||||
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| Phone | +1 305-642-4142 |
| Fax | 3056424143 |
Authorized person
| Name | DR. JOSSUE ALFONSO |
| Role | PRESIDENT |
| Phone | 3056424142 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN19316 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009946500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALFONSO, JOSSUE | Agent | 351 NW 42ND AVE, 402, MIAMI, FL 33126 |
| Name | Role | Address |
|---|---|---|
| ALFONSO, JOSSUE | President | 351 NW 42ND AVE, 402 MIAMI, FL 33126 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000036456 | ALFONSO DENTAL | ACTIVE | 2023-03-20 | 2028-12-31 | No data | 351 NW 42 AVE, SUITE 402, MIAMI, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-27 | 351 NW 42ND AVE, 402, MIAMI, FL 33126 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-27 | 351 NW 42ND AVE, 402, MIAMI, FL 33126 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-27 | 351 NW 42ND AVE, 402, MIAMI, FL 33126 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-17 |
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-02-02 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-29 |
| ANNUAL REPORT | 2016-01-26 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8100707301 | 2020-05-01 | 0455 | PPP | 351 NW 42ND AVE STE 402, MIAMI, FL, 33126-5688 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 23 Feb 2025
Sources: Florida Department of State
