| Entity Name: | FISHHAWK MODERN DENTISTRY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Nov 2019 (5 years ago) |
| Document Number: | P19000081593 |
| FEI/EIN Number | 84-3695479 |
| Mail Address: | 17000 RED HILL AVE, IRVINE, CA, 92614, US |
| Address: | 16509 FISHHAWK BLVD, LITHIA, FL, 33547, US |
| ZIP code: | 33547 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730726506 | 2019-11-29 | 2022-08-25 | PO BOX 920050, DALLAS, TX, 753920050, US | 16509 FISHHAWK BLVD, LITHIA, FL, 335473835, US | |||||||||||||
|
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| Phone | +1 813-563-8108 |
Authorized person
| Name | DR. KATIE L MCCANN LEE |
| Role | OWNER/GP |
| Phone | 8135638108 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Pham Minh B | President | 17000 RED HILL AVE, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Button Nicholas R | Secretary | 17000 RED HILL AVE, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Pham Minh B | Chief Financial Officer | 17000 RED HILL AVE, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Pham Minh B | Director | 17000 RED HILL AVE, IRVINE, CA, 92614 |
| Button Nicholas R | Director | 17000 RED HILL AVE, IRVINE, CA, 92614 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000127162 | FISHHAWK MODERN DENTISTRY | EXPIRED | 2019-12-02 | 2024-12-31 | No data | 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-06-13 | 115 N. CALHOUN ST., STE 4, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-03-16 |
| Reg. Agent Change | 2021-12-28 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-04-07 |
| Domestic Profit | 2019-11-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
