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LAKELAND MODERN DENTISTRY, PA. - Florida Company Profile

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Company Details

Entity Name: LAKELAND MODERN DENTISTRY, PA.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 24 Aug 2017 (8 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
City: Lakeland
County: Polk
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Button Nicholas R Secretary ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Pham Minh B Chief Financial Officer ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Button Nicholas R Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Pham Minh B Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
- Agent -
Cheng Elise President ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Ghazal Carolyn Director 17000 Red Hill Ave., Irvine, CA, 92614

National Provider Identifier

NPI Number:
1235649518
Certification Date:
2022-06-15

Authorized Person:

Name:
DR. MARY MABRY
Role:
OWNER DOCTOR
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
3039520892

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G17000132067 LAKELAND MODERN DENTISTRY ACTIVE 2017-12-04 2027-12-31 - 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT, 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 -

Documents

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

USAspending Awards / Financial Assistance

Date:
2020-04-29
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:
58352.00
Total Face Value Of Loan:
58352.00
Date:
2020-04-29
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:
58352.00
Total Face Value Of Loan:
58352.00

Paycheck Protection Program

Jobs Reported:
3
Initial Approval Amount:
$58,352
Date Approved:
2020-04-29
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$58,352
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Servicing Lender:
BMO Bank National Association
Use of Proceeds:
Payroll: $58,352

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Date of last update: 02 Aug 2025

Sources: Florida Department of State