| Entity Name: | GULFSHORE PEDIATRIC DENTISTRY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
GULFSHORE PEDIATRIC DENTISTRY, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 14 Apr 2014 (11 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 04 Aug 2015 (10 years ago) |
| Document Number: | P14000033719 |
| FEI/EIN Number |
46-5409759
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 9921 Corkscrew Road, Estero, FL, 33928, US |
| Mail Address: | 9921 CORKSCREW ROAD, ESTERO, FL, 33928, US |
| ZIP code: | 33928 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982082335 | 2015-05-18 | 2015-05-18 | 9921 CORKSCREW RD, ESTERO, FL, 33928, US | 9921 CORKSCREW RD, ESTERO, FL, 33928, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 239-776-2115 |
Authorized person
| Name | DR. TIA SHEA SAMMONS |
| Role | PEDIATRIC DENTIST |
| Phone | 2397762115 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | DN17564 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002138100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 076870700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TARVER EDWARD JIV | President | 9921 Corkscrew Rd, Estero, FL, 33928 |
| TARVER EDWARD JIV | Treasurer | 9921 Corkscrew Rd, Estero, FL, 33928 |
| TARVER EDWARD JIV | Director | 9921 Corkscrew Rd, Estero, FL, 33928 |
| SAMMONS TIA S | Vice President | 9921 Corkscrew Rd, Estero, FL, 33928 |
| SAMMONS TIA S | Secretary | 9921 Corkscrew Rd, Estero, FL, 33928 |
| SAMMONS TIA S | Director | 9921 Corkscrew Rd, Estero, FL, 33928 |
| TARVER EDWARD JIV | Agent | 9921 CORKSCREW ROAD, ESTERO, FL, 33928 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2015-08-04 | - | - |
| CHANGE OF MAILING ADDRESS | 2015-08-04 | 9921 Corkscrew Road, Estero, FL 33928 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-08-04 | 9921 CORKSCREW ROAD, ESTERO, FL 33928 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-03 | 9921 Corkscrew Road, Estero, FL 33928 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-01-25 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-18 |
| Amendment | 2015-08-04 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1861227302 | 2020-04-28 | 0455 | PPP | 9921 Corkscrew Rd, Estero, FL, 33928 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1554968308 | 2021-01-17 | 0455 | PPS | 9921 Corkscrew Rd, Estero, FL, 33928-3210 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Apr 2025
Sources: Florida Department of State
