| Entity Name: | CRESTVIEW SMILES, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Jan 2020 (5 years ago) |
| Document Number: | P20000002806 |
| FEI/EIN Number | 84-4335391 |
| Address: | 4400 E HIGHWAY 20, SUITE 101, NICEVILLE, FL, 32578, UN |
| Mail Address: | 4400 E HIGHWAY 20, SUITE 101, NICEVILLE, FL, 32578, UN |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386274777 | 2020-01-24 | 2020-01-24 | 4400 E HIGHWAY 20 STE 101, NICEVILLE, FL, 325789735, US | 5170 S FERDON BLVD, CRESTVIEW, FL, 325369258, US | |||||||||||||||
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| Phone | +1 850-897-4488 |
| Fax | 8508971446 |
Authorized person
| Name | LOVELYN SILVA |
| Role | OPERATIONS MANAGER |
| Phone | 8506996111 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BROUTIN OLIVIER | Agent | 955 Scenic Gulf Dr, Miramar Beach, FL, 32550 |
| Name | Role | Address |
|---|---|---|
| BROUTIN OLIVIER | Director | 955 Scenic Gulf Dr, Miramar Beach, FL, 32550 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000064696 | SMILEOLOGY | ACTIVE | 2022-05-25 | 2027-12-31 | No data | 4400 EAST HIGHWAY 20,SUITE 101, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-12 | 955 Scenic Gulf Dr, #510, Miramar Beach, FL 32550 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-18 |
| ANNUAL REPORT | 2021-01-29 |
| Domestic Profit | 2020-01-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
