| Entity Name: | CREEKSIDE DERMATOLOGY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Jul 2017 (8 years ago) |
| Date of dissolution: | 01 Apr 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 01 Apr 2018 (7 years ago) |
| Document Number: | P17000061754 |
| Address: | 8630A E COUNTY ROAD 466, THE VILLAGES, FL, 32162, US |
| Mail Address: | 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162, US |
| ZIP code: | 32162 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740703818 | 2017-07-20 | 2017-07-20 | 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 321623670, US | 8630 E COUNTY ROAD 466 STE A, THE VILLAGES, FL, 321625614, US | |||||||||||||||||||
|
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| Phone | +1 352-399-7295 |
| Fax | 3523997294 |
Authorized person
| Name | DR. DAVID CASPER |
| Role | PRESIDENT |
| Phone | 3523997295 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | 108772 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CASPER DAVID | Agent | 8620 EAST COUNTY ROAD 466, THE VILLAGES, FL, 32162 |
| Name | Role | Address |
|---|---|---|
| CASPER DAVID | President | 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-04-01 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2017-07-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
