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LAKE WORTH MODERN DENTISTRY, PA - Florida Company Profile

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Company Details

Entity Name: LAKE WORTH MODERN DENTISTRY, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 Jan 2020 (6 years ago)
Document Number: P20000006994
FEI/EIN Number 84-4513630
Address: 3980 S. MILITARY TRAIL, PALM SPRINGS, FL, 33463
Mail Address: ATTN: LEGAL DEPARTMENT, 17000 RED HILL AVE., IRVINE, CA, 92614
ZIP code: 33463
City: Lake Worth
County: Palm Beach
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Agent -
Tolmie Christopher K President ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Pham Minh B Treasurer ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Azadi Anthony A Secretary ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Azadi Anthony A Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Tolmie Christopher K Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614
Pham Minh K Director ATTN: LEGAL DEPARTMENT, IRVINE, CA, 92614

National Provider Identifier

NPI Number:
1306508130
Certification Date:
2021-10-08

Authorized Person:

Name:
CHRISTOPHER TOLMIE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
3039520892
Fax:
5615848152

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G21000120273 LAKE WORTH MODERN DENTISTRY ACTIVE 2021-09-16 2026-12-31 - 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 2024-04-17
ANNUAL REPORT 2023-04-14
ANNUAL REPORT 2022-03-16
Reg. Agent Change 2022-01-14
ANNUAL REPORT 2021-04-09
Domestic Profit 2020-01-28

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Date of last update: 02 Aug 2025

Sources: Florida Department of State