| Entity Name: | DAVENPORT MODERN DENTISTRY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 02 Oct 2019 (5 years ago) |
| Document Number: | P19000074195 |
| FEI/EIN Number | 84-3251943 |
| Mail Address: | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT, IRVINE, CA 92614 |
| Address: | 43522 US HWY 27 N, DAVENPORT, FL 33837 |
| ZIP code: | 33837 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568005999 | 2019-10-17 | 2022-06-14 | PO BOX 920050, DALLAS, TX, 753920050, US | 1159 POSNER BLVD, DAVENPORT, FL, 338373664, US | |||||||||||||
|
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| Phone | +1 863-777-9890 |
Authorized person
| Name | DR. MINH B PHAM |
| Role | OWNER/DDS |
| Phone | 8637779890 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Pham, Minh B. | President | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT IRVINE, CA 92614 |
| Name | Role | Address |
|---|---|---|
| Button, Nicholas R. | Secretary | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT IRVINE, CA 92614 |
| Name | Role | Address |
|---|---|---|
| Pham, Minh B. | Chief Financial Officer | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT IRVINE, CA 92614 |
| Name | Role | Address |
|---|---|---|
| Button, Nicholas R. | Director | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT IRVINE, CA 92614 |
| Pham, Minh B. | Director | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT IRVINE, CA 92614 |
| Ansari, Omeir | Director | 17000 RED HILL AVENUE, ATTN: LEGAL DEPARTMENT IRVINE, CA 92614 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000109124 | DAVENPORT MODERN DENTISTRY | EXPIRED | 2019-10-07 | 2024-12-31 | No data | 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-27 | 43522 US HWY 27 N, DAVENPORT, FL 33837 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-06-13 | 115 N. CALHOUN ST., STE 4, TALLAHASSEE, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-25 | 43552 US HWY 27 N, DAVENPORT, FL 33837 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-03-16 |
| Reg. Agent Change | 2021-12-06 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-04-07 |
| Domestic Profit | 2019-10-02 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
