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  5. KELLOGG ENDODONTICS, P.A.

KELLOGG ENDODONTICS, P.A.

Company Details

Entity Name: KELLOGG ENDODONTICS, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Jun 2014 (11 years ago)
Document Number: P14000048843
FEI/EIN Number 47-1001422
Address: 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578, US
Mail Address: 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578, US
ZIP code: 33578
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1497282859 2017-05-16 2022-07-21 10028 WATER WORKS LN, RIVERVIEW, FL, 335785301, US 10028 WATER WORKS LN, RIVERVIEW, FL, 335785301, US

Contacts
Phone +1 813-741-1900
Fax 8137411901

Authorized person
Name DR. DAVID KELLOGG
Role ENDODONTIST
Phone 8133680158

Taxonomy
Taxonomy Code 1223E0200X - Endodontist
License Number DN20366
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KELLOGG ENDODONTICS, P.A. 401(K) PLAN 2023 471001422 2024-05-09 KELLOGG ENDODONTICS, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 8137411900
Plan sponsor’s address 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-09
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
KELLOGG ENDODONTICS, P.A. 401(K) PLAN 2022 471001422 2023-05-27 KELLOGG ENDODONTICS, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 8137411900
Plan sponsor’s address 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-27
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
KELLOGG ENDODONTICS, P.A. 401(K) PLAN 2021 471001422 2022-06-01 KELLOGG ENDODONTICS, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 8137411900
Plan sponsor’s address 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-06-01
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
KELLOGG ENDODONTICS, P.A. 401(K) PLAN 2020 471001422 2021-07-01 KELLOGG ENDODONTICS, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 8137411900
Plan sponsor’s address 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-07-01
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
KELLOGG ENDODONTICS, P.A. 401(K) PLAN 2019 471001422 2020-05-14 KELLOGG ENDODONTICS, P.A. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 8137411900
Plan sponsor’s address 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-14
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KELLOGG DAVID Agent 10028 WATER WORKS LANE, RIVERVIEW, FL, 33578

President

Name Role Address
Kellogg David President 10028 Water Works Lane, Riverview, FL, 33578

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2018-01-11 10028 WATER WORKS LANE, RIVERVIEW, FL 33578 No data
CHANGE OF PRINCIPAL ADDRESS 2017-06-13 10028 WATER WORKS LANE, RIVERVIEW, FL 33578 No data
CHANGE OF MAILING ADDRESS 2017-06-13 10028 WATER WORKS LANE, RIVERVIEW, FL 33578 No data

Documents

Name Date
ANNUAL REPORT 2025-01-18
ANNUAL REPORT 2024-01-16
ANNUAL REPORT 2023-01-11
ANNUAL REPORT 2022-01-23
ANNUAL REPORT 2021-01-12
ANNUAL REPORT 2020-03-19
ANNUAL REPORT 2019-01-18
ANNUAL REPORT 2018-01-11
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-02-20

Related by officers

KELLOGG DAVID

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Related by address

10028 WATER WORKS LANE, RIVERVIEW, FL, 33578, US

COLON FAMILY CHIROPRACTIC PLLC

10028 WATER WORKS LANE, RIVERVIEW, FL, 33578, US

COLON FAMILY CHIROPRACTIC PLLC

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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