| Entity Name: | JACKSONVILLE FAMILY DENTISTRY AT SOUTHSIDE, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Sep 2017 (7 years ago) |
| Date of dissolution: | 01 Oct 2020 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 01 Oct 2020 (4 years ago) |
| Document Number: | P17000075479 |
| FEI/EIN Number | 82-2805836 |
| Address: | 8101 SOUTHSIDE BLVD, #8, JACKSONVILLE, FL, 32256 |
| Mail Address: | 4366 Seabreeze Dr, Jacksonville Beach, FL, 32250, US |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073024006 | 2017-10-17 | 2017-10-17 | 100 FAIRWAY PARK BLVD UNIT 512, PONTE VEDRA BEACH, FL, 320822667, US | 8101 SOUTHSIDE BLVD STE 8, JACKSONVILLE, FL, 322568005, US | |||||||||||||||||||
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| Phone | +1 904-210-5348 |
| Phone | +1 904-641-2655 |
Authorized person
| Name | DR. BRYAN KEITH BLANKENSHIP |
| Role | PRESIDENT |
| Phone | 9042105348 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 16941 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BLANKENSHIP BRYAN KDDS | Agent | 4366 Seabreeze Dr, Jacksonville Beach, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| BLANKENSHIP BRYAN KDDS | President | 4366 Seabreeze Dr, Jacksonville Beach, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| Blankenship APRIL M | Secretary | 4366 Seabreeze Dr, Jacksonville Beach, FL, 32250 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000122619 | DR JAMES E. GAFF | EXPIRED | 2017-11-07 | 2022-12-31 | No data | 8101 SOUTHSIDE BLVD #8, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-11 | 8101 SOUTHSIDE BLVD, #8, JACKSONVILLE, FL 32256 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-11 | 4366 Seabreeze Dr, Jacksonville Beach, FL 32250 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-10-01 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-04-11 |
| Domestic Profit | 2017-09-18 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
