| Entity Name: | DENTAL SPECIALISTS OF PEMBROKE PINES GROUP CO |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Aug 2017 (8 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 14 Sep 2017 (7 years ago) |
| Document Number: | P17000068974 |
| FEI/EIN Number | 82-2516138 |
| Address: | 12558 Pines Blvd, Pembroke Pines, FL 33027 |
| Mail Address: | 12558 Pines Blvd, Pembroke Pines, FL 33027 |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073030755 | 2017-08-24 | 2017-08-24 | 12558 PINES BLVD, PEMBROKE PINES, FL, 330271713, US | 12558 PINES BLVD, PEMBROKE PINES, FL, 330271713, US | |||||||||||||||||
|
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| Phone | +1 305-220-8911 |
Authorized person
| Name | DR. IVAN PELTON |
| Role | CLINICAL DIRECTOR |
| Phone | 3052208911 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN5838 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PELTON, IVAN A, DDS | Agent | 12558 Pines Blvd, Pembroke Pines, FL 33027 |
| Name | Role | Address |
|---|---|---|
| PELTON, IVAN S, DDS | President | 9 SW 17 STREET, FORT LAUDERDALE, FL 33315 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-05 | 12558 Pines Blvd, Pembroke Pines, FL 33027 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-05 | 12558 Pines Blvd, Pembroke Pines, FL 33027 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-05 | 12558 Pines Blvd, Pembroke Pines, FL 33027 | No data |
| AMENDMENT | 2017-09-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-09-14 | PELTON, IVAN A, DDS | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-24 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-04-08 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-17 |
| Amendment | 2017-09-14 |
| Domestic Profit | 2017-08-16 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
