| Entity Name: | TIM M. VERWEST, D.M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 12 Dec 2012 (12 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 11 Dec 2022 (2 years ago) |
| Document Number: | P12000101312 |
| FEI/EIN Number | 46-1604794 |
| Address: | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 |
| Mail Address: | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457791238 | 2013-06-26 | 2013-06-26 | 9371 CYPRESS LAKE DR, SUITE 7, FORT MYERS, FL, 339194939, US | 9371 CYPRESS LAKE DR, SUITE 7, FORT MYERS, FL, 339194939, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 239-482-2722 |
Authorized person
| Name | DR. TIM VERWEST |
| Role | OWNER |
| Phone | 2394822722 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN0012089 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 073699600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 073699601 |
| State | FL |
| Name | Role |
|---|---|
| GSK REGISTERED AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| VERWEST, TIM M, Dr. | President | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 |
| Name | Role | Address |
|---|---|---|
| VERWEST, TIM M, Dr. | Secretary | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 |
| Name | Role | Address |
|---|---|---|
| VERWEST, TIM M, Dr. | Treasurer | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-12-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 2021-12-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-12 | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-12 | 8016 SUMMERLIN LAKES DRIVE, FORT MYERS, FL 33907 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-12 | GSK REGISTERED AGENTS, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-09-22 |
| REINSTATEMENT | 2022-12-11 |
| REINSTATEMENT | 2021-12-01 |
| ANNUAL REPORT | 2020-01-30 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-03-21 |
| ANNUAL REPORT | 2017-03-01 |
| ANNUAL REPORT | 2016-02-01 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 22 Feb 2025
Sources: Florida Department of State
