| Entity Name: | LAKELAND MODERN DENTISTRY, PA. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Aug 2017 (7 years ago) |
| Document Number: | P17000071376 |
| FEI/EIN Number | 82-2837300 |
| Address: | 4620 S FLORIDA AVE STE 120, LAKELAND, FL, 33813 |
| Mail Address: | ATTN: LEGAL DEPARTMENT, 17000 RED HILL AVE, IRVINE, CA, 92614 |
| ZIP code: | 33813 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235649518 | 2017-10-02 | 2022-06-15 | PO BOX 920050, DALLAS, TX, 753920050, US | 4620 S FLORIDA AVE STE 120, LAKELAND, FL, 338132166, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 714-845-8890 |
| Fax | 3039520892 |
| Phone | +1 863-216-5765 |
Authorized person
| Name | DR. MARY MABRY |
| Role | OWNER DOCTOR |
| Phone | 8632165765 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Mabry Mary | President | ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Button Nicholas R | Secretary | ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Pham Minh B | Chief Financial Officer | ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Button Nicholas R | Director | ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Pham Minh B | Director | ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Mabry Mary | Director | ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000132067 | LAKELAND MODERN DENTISTRY | ACTIVE | 2017-12-04 | 2027-12-31 | No data | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-06-13 | 115 N. CALHOUN ST., STE 4, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-03-21 |
| Reg. Agent Change | 2022-01-14 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-26 |
| Domestic Profit | 2017-08-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
