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WINTER HAVEN MODERN DENTISTRY, PA - Florida Company Profile

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Company Details

Entity Name: WINTER HAVEN MODERN DENTISTRY, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 18 Nov 2019 (6 years ago)
Document Number: P19000085821
FEI/EIN Number 84-3753098
Mail Address: ATTN: LEGAL DEPARTMENT, 17000 RED HILL AVENUE, IRVINE, CA, 92614
Address: 565 CYPRESS GARDENS BLVD, WINTER HAVEN, FL, 33880
ZIP code: 33880
City: Winter Haven
County: Polk
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Mabry Mary President ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Button Nicholas R Secretary ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Pham Minh B Chief Financial Officer ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Button Nicholas R Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Pham Minh B Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Mabry Mary Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
- Agent -

National Provider Identifier

NPI Number:
1629615497

Authorized Person:

Name:
DR. KATIE L MCCANN LEE
Role:
OWNER/GP
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000000327 WINTER HAVEN MODERN DENTISTRY ACTIVE 2020-01-02 2025-12-31 - 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2023-06-13 115 N. CALHOUN ST., STE 4, TALLAHASSEE, FL 32301 -

Documents

Name Date
ANNUAL REPORT 2024-04-29
ANNUAL REPORT 2023-04-17
ANNUAL REPORT 2022-03-22
ANNUAL REPORT 2021-04-19
ANNUAL REPORT 2020-04-24
Domestic Profit 2019-11-18

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Date of last update: 01 Aug 2025

Sources: Florida Department of State