| Entity Name: | CHAMPAGNE DENTAL CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Apr 2018 (7 years ago) |
| Document Number: | P18000034608 |
| FEI/EIN Number | 82-5210299 |
| Address: | 2385 NW EXECUTIVE CENTER DRIVE, SUITE 100, BOCA RATON, FL, 33431, US |
| Mail Address: | 2385 NW EXECUTIVE CENTER DRIVE, SUITE 100, BOCA RATON, FL, 33431, US |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265918312 | 2018-07-12 | 2018-07-12 | 2385 NW EXECUTIVE CENTER DR STE 100, BOCA RATON, FL, 334318510, US | 1330 S BELCHER RD, CLEARWATER, FL, 337643713, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-251-1907 |
| Fax | 7275351185 |
| Phone | +1 727-535-3233 |
Authorized person
| Name | HOLLY KAY |
| Role | VICE PRESIDENT |
| Phone | 7272511907 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN11998 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN19345 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN19494 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | CATHERINE DE LA TORRE DMD |
| Number | 1649568767 |
| State | FL |
| Issuer | GEORGE HITZEL DDS |
| Number | 1063545242 |
| State | FL |
| Issuer | LINDSEY REZNIK DMD |
| Number | 1164710976 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KAY HOLLY | Agent | 1330 SOUTH BELCHER RD, CLEARWATER, FL, 33764 |
| Name | Role | Address |
|---|---|---|
| GEORGE E. HITZEL DDS PA | Vice President | 1330 SOUTH BELCHER ROAD, CLEARWATER, FL, 33764 |
| KAY HOLLY | Vice President | 1330 SOUTH BELCHER ROAD, CLEARWATER, FL, 33764 |
| Name | Role | Address |
|---|---|---|
| HITZEL GEORGE E | President | 1330 SOUTH BELCHER RD, CLEARWATER, FL, 33764 |
| Name | Role | Address |
|---|---|---|
| Guardian Dentistry Partners | Officer | 2385 NW EXECUTIVE CENTER DRIVE, BOCA RATON, FL, 33431 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000076429 | CHAMPAGNE DENTAL CARE | EXPIRED | 2019-07-15 | 2024-12-31 | No data | 2385 NW EXECUTIVE CENTER DR, #100, BOCA RATON, FL, 33431 |
| G18000069519 | GEORGE E. HITZEL DDS | ACTIVE | 2018-06-19 | 2028-12-31 | No data | 2385 NW EXECUTIVE CENTER DR, #100, BOCA RATON, FL, 33431 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-03-01 |
| AMENDED ANNUAL REPORT | 2020-05-14 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-06-17 |
| Domestic Profit | 2018-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
