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  5. SURFSIDE ORTHODONTICS, PA

SURFSIDE ORTHODONTICS, PA

Company Details

Entity Name: SURFSIDE ORTHODONTICS, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 15 Jan 2013 (12 years ago)
Document Number: P13000005454
FEI/EIN Number 263736736
Address: 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
Mail Address: 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
ZIP code: 32547
County: Okaloosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1205176021 2013-02-15 2013-02-15 28 RACETRACK RD NW, FORT WALTON BEACH, FL, 325471640, US 28 RACETRACK RD NW, FORT WALTON BEACH, FL, 325471640, US

Contacts
Phone +1 850-863-2122
Fax 8508635812

Authorized person
Name DR. BRODIE BOWMAN
Role OWNER
Phone 8508632122

Taxonomy
Taxonomy Code 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
License Number 16286
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2023 263736736 2024-09-06 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2022 263736736 2023-09-19 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2021 263736736 2022-09-09 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2020 263736736 2021-09-28 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2019 263736736 2020-09-02 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2018 263736736 2019-09-18 SURFSIDE ORTHODONTICS, PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2017 263736736 2018-10-01 SURFSIDE ORTHODONTICS, PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2016 263736736 2017-09-11 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2017-09-11
Name of individual signing BRODIE L. BOWMAN, D.D.S.
Valid signature Filed with authorized/valid electronic signature
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2015 263736736 2016-10-07 SURFSIDE ORTHODONTICS, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2016-10-07
Name of individual signing BRODIE L. BOWMAN, D.D.S.
Valid signature Filed with authorized/valid electronic signature
SURFSIDE ORTHODONTICS RETIREMENT PLAN & TRUST 2014 263736736 2015-10-06 SURFSIDE ORTHODONTICS, PA 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 8508632122
Plan sponsor’s address 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2015-10-06
Name of individual signing BRODIE L. BOWMAN, D.D.S.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BOWMAN BRODIE Agent 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547

Director

Name Role Address
BOWMAN BRODIE L Director 28 RACETRACK ROAD NW, FORT WALTON BEACH, FL, 32547

Documents

Name Date
ANNUAL REPORT 2024-02-16
ANNUAL REPORT 2023-01-22
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-01-15
ANNUAL REPORT 2020-01-14
ANNUAL REPORT 2019-02-12
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-25
ANNUAL REPORT 2016-01-28
ANNUAL REPORT 2015-01-13

Related by officers

BOWMAN BRODIE L

BLB PROPERTY HOLDINGS, LLC WAVE A SMILE, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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