| Entity Name: | LAURA LONDONO DMD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 10 Jul 2014 (11 years ago) |
| Document Number: | P14000058567 |
| FEI/EIN Number | 47-1303046 |
| Address: | 4147 OPEN WAY, COOPER CITY, FL 33026 |
| Mail Address: | 4147 OPEN WAY, COOPER CITY, FL 33026 |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003331034 | 2017-08-10 | 2018-06-16 | 4147 OPEN WAY, HOLLYWOOD, FL, 330261154, US | 7800 N UNIVERSITY DR STE 101, TAMARAC, FL, 333212113, US | |||||||||||||||||||||||||||
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| Phone | +1 786-554-6309 |
| Phone | +1 954-670-1170 |
| Fax | 7865546309 |
Authorized person
| Name | DR. LAURA E LONDONO |
| Role | PRESIDENT |
| Phone | 7865546309 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 20878 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 661726 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LONDONO, LAURA | Agent | 4147 OPEN WAY, COOPER CITY, FL 33026 |
| Name | Role | Address |
|---|---|---|
| LONDONO, LAURA | President | 4147 Open Way, Cooper City, FL 33026 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000001325 | ORAL ONE DENTAL GROUP | ACTIVE | 2018-01-03 | 2028-12-31 | No data | 4147 OPEN WAY, COOPER CITY, FL, 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-22 | 4147 OPEN WAY, COOPER CITY, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-22 | 4147 OPEN WAY, COOPER CITY, FL 33026 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-22 | 4147 OPEN WAY, COOPER CITY, FL 33026 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-02-23 |
| ANNUAL REPORT | 2020-03-10 |
| ANNUAL REPORT | 2019-03-07 |
| ANNUAL REPORT | 2018-04-15 |
| ANNUAL REPORT | 2017-04-22 |
| ANNUAL REPORT | 2016-03-27 |
| ANNUAL REPORT | 2015-04-26 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
