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  5. UNIVERSAL SMILES DENTISTRY PA

UNIVERSAL SMILES DENTISTRY PA

Company Details

Entity Name: UNIVERSAL SMILES DENTISTRY PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 14 Aug 2012 (12 years ago)
Document Number: P12000070134
FEI/EIN Number 40-6781561
Address: 2102 S Ridgewood Ave, # 11, Edgewater, FL, 32141, US
Mail Address: 2102 S Ridgewood Ave, # 11, Edgewater, FL, 32141, US
ZIP code: 32141
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1578999462 2013-09-24 2013-09-24 6735 CONROY WINDERMERE RD, SUITE# 202, ORLANDO, FL, 328353565, US 6735 CONROY WINDERMERE RD, SUITE# 202, ORLANDO, FL, 328353565, US

Contacts
Phone +1 407-910-1178

Authorized person
Name DR. SURENDRA G SIRIVOLU
Role PRACTICE MANAGER
Phone 3212783933

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number DN17057
State FL
Is Primary Yes
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number DN17923
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSAL SMILES DENTISTRY PA DEFINED BENEFIT PLAN 2023 460781561 2024-10-14 UNIVERSAL SMILES DENTISTRY PA 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 3867759933
Plan sponsor’s address 1025 S.VOLUSIA AVE, ORANGE CITY, FL, 32763
UNIVERSAL SMILES DENTISTRY PA PROFIT SHARING PLAN 2023 460781561 2024-10-14 UNIVERSAL SMILES DENTISTRY PA 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 3867759933
Plan sponsor’s address 1025 S.VOLUSIA AVE, ORANGE CITY, FL, 32763
UNIVERSAL SMILES DENTISTRY PA DEFINED BENEFIT PLAN 2022 460781561 2023-10-12 UNIVERSAL SMILES DENTISTRY PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 3867759933
Plan sponsor’s address 1025 S.VOLUSIA AVE, ORANGE CITY, FL, 32763
UNIVERSAL SMILES DENTISTRY PA PROFIT SHARING PLAN 2022 460781561 2023-10-12 UNIVERSAL SMILES DENTISTRY PA 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 3867759933
Plan sponsor’s address 1025 S.VOLUSIA AVE, ORANGE CITY, FL, 32763
UNIVERSAL SMILES DENTISTRY PA DEFINED BENEFIT PLAN 2021 460781561 2022-10-05 UNIVERSAL SMILES DENTISTRY PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 3867759933
Plan sponsor’s address 1025 S.VOLUSIA AVE, ORANGE CITY, FL, 32763
UNIVERSAL SMILES DENTISTRY PA PROFIT SHARING PLAN 2021 460781561 2022-10-05 UNIVERSAL SMILES DENTISTRY PA 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 3867759933
Plan sponsor’s address 1025 S.VOLUSIA AVE, ORANGE CITY, FL, 32763

Agent

Name Role Address
SIRIVOLU SURENDRA G Agent 2102 S Ridgewood Ave, Edgewater, FL, 32141

President

Name Role Address
SIRIVOLU SURENDRA G President 2102 S Ridgewood Ave, Edgewater, FL, 32141

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-01-10 2102 S Ridgewood Ave, # 11, Edgewater, FL 32141 No data
CHANGE OF MAILING ADDRESS 2023-01-10 2102 S Ridgewood Ave, # 11, Edgewater, FL 32141 No data
REGISTERED AGENT NAME CHANGED 2023-01-10 SIRIVOLU, SURENDRA GOPAL No data
REGISTERED AGENT ADDRESS CHANGED 2023-01-10 2102 S Ridgewood Ave, # 11, Edgewater, FL 32141 No data

Documents

Name Date
ANNUAL REPORT 2024-04-03
ANNUAL REPORT 2023-01-10
ANNUAL REPORT 2022-03-27
ANNUAL REPORT 2021-03-14
ANNUAL REPORT 2020-02-04
ANNUAL REPORT 2019-02-14
ANNUAL REPORT 2018-01-18
ANNUAL REPORT 2017-04-24
ANNUAL REPORT 2016-04-14
ANNUAL REPORT 2015-04-14

Related by officers

SIRIVOLU SURENDRA G

STARBASE INSTRUMENTS, LLC UNIVERSAL SMILES DENTISTRY VILLAGES PA UNIVERSAL SMILES DENTISTRY DELAND PA STARBASE DENTAL, INC.

Related by address

2102 S Ridgewood Ave, # 11, Edgewater, FL, 32141, US

SIRI MANAGEMENT SOLUTIONS LLC

2102 S Ridgewood Ave, # 11, Edgewater, FL, 32141, US

SIRI MANAGEMENT SOLUTIONS LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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