| Entity Name: | FIRST COAST ORAL AND FACIAL SURGERY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 31 Jan 2012 (13 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P12000010499 |
| FEI/EIN Number | APPLIED FOR |
| Mail Address: | 7175-01 US HIGHWAY 17 SOUTH, FLEMING ISLAND, FL, 32003 |
| Address: | 319 WEST TOWN PLACE, SUITE 3, ST AUGUSTINE, FL, 32092 |
| ZIP code: | 32092 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356601249 | 2012-05-24 | 2012-05-24 | 319 WEST TOWN PLACE #2, ST. AUGUSTINE, FL, 32092, US | 319 W TOWN PLACE, SUITE 2, ST AUGUSTINE, FL, 32092, US | |||||||||||||||
|
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| Phone | +1 904-529-8889 |
| Fax | 9045298893 |
Authorized person
| Name | DR. THOMAS E STAKEM |
| Role | PRESIDENT |
| Phone | 9045298889 |
Taxonomy
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| STAKEM THOMAS E | Agent | 7175-01 US HIGHWAY 17 SOUTH, FLEMING ISLAND, FL, 32003 |
| Name | Role | Address |
|---|---|---|
| STAKEM THOMAS E | President | 7175-01 US HIGHWAY 17 SOUTH, FLEMING ISLAND, FL, 32003 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-03-23 |
| ANNUAL REPORT | 2017-03-14 |
| ANNUAL REPORT | 2016-04-10 |
| ANNUAL REPORT | 2015-02-24 |
| ANNUAL REPORT | 2014-04-18 |
| ANNUAL REPORT | 2013-04-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
