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PONTE VEDRA COSMETIC DENTISTRY, P.A. - Florida Company Profile

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Company Details

Entity Name: PONTE VEDRA COSMETIC DENTISTRY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 11 May 2012 (13 years ago)
Last Event: AMENDMENT
Event Date Filed: 15 Jun 2017 (8 years ago)
Document Number: P12000044685
FEI/EIN Number 45-5276363
Address: 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082, US
Mail Address: 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082, US
ZIP code: 32082
City: Ponte Vedra Beach
County: St. Johns
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
NEAL KEVIN L President 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082
WINTER MICHAEL C Vice President 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082
MAPLES ANDREW W Secretary 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082
MAPLES BRIAN W Treasurer 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082
NEAL KEVIN L Agent 100 PROFESSIONAL DRIVE, PONTE VEDRA BEACH, FL, 32082

National Provider Identifier

NPI Number:
1396000329

Authorized Person:

Name:
MRS. KAMALA RUDOLPH
Role:
PRACTICE ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
9042855346

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G17000017555 PONTE VEDRA PREMIER DENTAL EXPIRED 2017-02-16 2022-12-31 - 100 PROFESSIONAL DRIVE, PONTE VEDRA, FL, 32082

Events

Event Type Filed Date Value Description
AMENDMENT 2017-06-15 - -
AMENDMENT 2016-10-27 - -

Documents

Name Date
ANNUAL REPORT 2024-03-06
ANNUAL REPORT 2023-03-02
ANNUAL REPORT 2022-03-23
ANNUAL REPORT 2021-02-17
ANNUAL REPORT 2020-04-28
ANNUAL REPORT 2019-02-27
ANNUAL REPORT 2018-03-10
Amendment 2017-06-15
ANNUAL REPORT 2017-01-24
Amendment 2016-10-27

Paycheck Protection Program

Jobs Reported:
21
Initial Approval Amount:
$151,415
Date Approved:
2021-01-19
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$151,415
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
$152,592.67
Servicing Lender:
Cogent Bank
Use of Proceeds:
Payroll: $151,411
Utilities: $1

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Date of last update: 02 Aug 2025

Sources: Florida Department of State