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WEST PINES MODERN DENTISTRY, PA - Florida Company Profile

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Company Details

Entity Name: WEST PINES MODERN DENTISTRY, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 Mar 2017 (8 years ago)
Document Number: P17000027993
FEI/EIN Number 82-1089818
Mail Address: ATTN: LEGAL DEPT., 17000 RED HILL AVENUE, IRVINE, CA, 92614
Address: 18312 Pines Blvd, Pembroke Pines, FL, 33029, US
ZIP code: 33029
City: Hollywood
County: Broward
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Pham Minh B President ATTN: LEGAL DEPT., IRVINE, CA, 92614
Gonzales Nathaniel S Secretary ATTN: LEGAL DEPT., IRVINE, CA, 92614
Pham Minh B Chief Financial Officer ATTN: LEGAL DEPT., IRVINE, CA, 92614
Gonzales Nathaniel S Director ATTN: LEGAL DEPT., IRVINE, CA, 92614
Pham Minh B Director ATTN: LEGAL DEPT., IRVINE, CA, 92614
Ghazal Carolyn B Director 17000 Red Hill Ave., Irvine, CA, 92614
- Agent -

National Provider Identifier

NPI Number:
1134654064

Authorized Person:

Name:
KATIE MCCANN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
7862040714

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G17000117851 WEST PINES MODERN DENTISTRY ACTIVE 2017-10-25 2027-12-31 - 17000 RED HILL AVENUE, ATTENTION: RAELEA APOLITO, IRVINE, CA, 92614

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2023-06-13 115 N. CALHOUN ST., STE 4, TALLAHASSEE, FL 32301 -
CHANGE OF PRINCIPAL ADDRESS 2019-04-30 18312 Pines Blvd, Pembroke Pines, FL 33029 -

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-04-17
ANNUAL REPORT 2022-03-23
Reg. Agent Change 2021-09-02
ANNUAL REPORT 2021-04-19
ANNUAL REPORT 2020-05-12
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-04-26
Domestic Profit 2017-03-28

USAspending Awards / Financial Assistance

Date:
2020-04-30
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
58317.00
Total Face Value Of Loan:
58317.00
Date:
2020-04-30
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
58317.00
Total Face Value Of Loan:
58317.00

Paycheck Protection Program

Jobs Reported:
4
Initial Approval Amount:
$58,317
Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$58,317
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$59,023.28
Servicing Lender:
BMO Bank National Association
Use of Proceeds:
Payroll: $58,317

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Date of last update: 02 Aug 2025

Sources: Florida Department of State