| Entity Name: | THE DENTIST AT THE VILLAGES, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Apr 2015 (10 years ago) |
| Date of dissolution: | 23 Feb 2023 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 Feb 2023 (2 years ago) |
| Document Number: | P15000031408 |
| FEI/EIN Number | 47-3692638 |
| Address: | 307 LAGRANDE BLVD, LADY LAKE, FL, 32159, US |
| Mail Address: | 307 LAGRANDE BLVD, LADY LAKE, FL, 32159, US |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760938005 | 2016-08-28 | 2016-08-28 | 307 LAGRANDE BLVD, LADY LAKE, FL, 321592388, US | 307 LAGRANDE BLVD, LADY LAKE, FL, 321592388, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 352-753-5789 |
Authorized person
| Name | DR. CARLOS MEDINA |
| Role | OWNWE/DENTIST |
| Phone | 3527535789 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| License Number | DN 15845 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CARUSO STEVE | Agent | 486 N HARBOR CITY BLVD, MELBOURNE, FL, 32935 |
| Name | Role | Address |
|---|---|---|
| MEDINA CARLOS DMD | President | 307 LAGRANDE BLVD, LADY LAKE, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-02-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-11 | CARUSO, STEVE | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-02-23 |
| ANNUAL REPORT | 2022-03-11 |
| AMENDED ANNUAL REPORT | 2021-11-16 |
| ANNUAL REPORT | 2021-03-29 |
| ANNUAL REPORT | 2020-05-12 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-04-13 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-03-14 |
| Domestic Profit | 2015-04-06 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
