| Entity Name: | AMERICAN PEDIATRIC DENTAL DORAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Apr 2014 (11 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 07 Apr 2022 (3 years ago) |
| Document Number: | P14000029723 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 2970 Brandywine Road, Suite 200, Atlanta, GA, 30341, US |
| Mail Address: | 2970 Brandywine Road, Suite 200, Atlanta, GA, 30341, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063816122 | 2014-10-20 | 2014-10-20 | 7950 NW 53RD ST, SUITE 200, DORAL, FL, 331664653, US | 7950 NW 53RD ST, SUITE 200, DORAL, FL, 331664653, US | |||||||||||||||||||||||
|
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| Phone | +1 305-407-2134 |
Authorized person
| Name | DR. WILLIAM ANTONIO PENA |
| Role | PRESIDENT |
| Phone | 3054072134 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN17608 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000641100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| Santiago Gerardo | Auth | 2970 Brandywine Road, Atlanta, GA, 30341 |
| Name | Role | Address |
|---|---|---|
| Santiago Gerardo | President | 2970 Brandywine Road, Atlanta, GA, 30341 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000102976 | AMERICAN PEDIATRIC DENTAL GROUP | EXPIRED | 2014-10-09 | 2024-12-31 | No data | 10021 PINES BLVD., SUITE 100, PEMBROKE PINES, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-05 | 2970 Brandywine Road, Suite 200, Atlanta, GA 30341 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-05 | 2970 Brandywine Road, Suite 200, Atlanta, GA 30341 | No data |
| AMENDMENT | 2022-04-07 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-09-14 | CT CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-09-14 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J22000030447 | TERMINATED | 1000000907268 | BROWARD | 2022-01-14 | 2032-01-19 | $ 5,794.65 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2023-03-02 |
| Amendment | 2022-04-07 |
| ANNUAL REPORT | 2022-03-22 |
| Reg. Agent Change | 2021-09-14 |
| ANNUAL REPORT | 2021-04-25 |
| ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-03-08 |
| ANNUAL REPORT | 2017-02-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
