| Entity Name: | TARPON RIVER DENTAL, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Sep 2019 (5 years ago) |
| Document Number: | P19000075484 |
| FEI/EIN Number | 84-3301250 |
| Address: | 416 SE 11TH COURT, FORT LAUDERDALE, FL, 33316, US |
| Mail Address: | 416 SE 11TH COURT, FORT LAUDERDALE, FL, 33316, US |
| ZIP code: | 33316 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134762818 | 2019-10-24 | 2019-10-24 | 416 SE 11TH CT, FORT LAUDERDALE, FL, 333161144, US | 416 SE 11TH CT, FORT LAUDERDALE, FL, 333161144, US | |||||||||||||
|
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| Phone | +1 954-663-2582 |
Authorized person
| Name | DR. MARIEL PETRUK |
| Role | OWNER |
| Phone | 9546632582 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| STANFORD ENTITY MANAGEMENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PETRUK MARIEL | President | 416 SE 11TH COURT, FORT LAUDERDALE, FL, 33316 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-12 | STANFORD ENTITY MANAGEMENT LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-12 | 3109 Grand Ave, 321, Coconut Grove, FL 33133 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-06-01 |
| Domestic Profit | 2019-09-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
