| Entity Name: | SMILING KIDDS DENTISTRY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Feb 2020 (5 years ago) |
| Document Number: | P20000015136 |
| FEI/EIN Number | 844820878 |
| Address: | 3020 HARTLEY ROAD, STE. 210, JACKSONVILLE, FL, 32257, US |
| Mail Address: | 3020 HARTLEY ROAD, STE. 210, JACKSONVILLE, FL, 32257, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720780299 | 2023-03-20 | 2023-03-20 | 3020 HARTLEY RD STE 210, JACKSONVILLE, FL, 322578206, US | 7101 NORMANDY BLVD, JACKSONVILLE, FL, 322056211, US | |||||||||||||
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| Phone | +1 855-974-5437 |
Authorized person
| Name | LINDSEY BOHANNON |
| Role | CREDENTIALING MANAGER |
| Phone | 9043957772 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WEAVER ANDREW | Agent | 3020 HARTLEY ROAD, STE. 210, JACKSONVILLE, FL, 32257 |
| Name | Role | Address |
|---|---|---|
| WEAVER ROBERT VDMD | Director | 3020 HARTLEY ROAD, STE. 210, JACKSONVILLE, FL, 32257 |
| WEAVER J. PATRICK DMD | Director | 3020 HARTLEY ROAD, STE. 210, JACKSONVILLE, FL, 32257 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000163081 | SEASIDE CHILDREN'S DENTISTRY | ACTIVE | 2020-12-23 | 2025-12-31 | No data | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| G20000163090 | RIVER CITY PEDIATRIC DENTISTRY | ACTIVE | 2020-12-23 | 2025-12-31 | No data | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| G20000152146 | ECONOMY DENTISTRY FOR CHILDREN | ACTIVE | 2020-12-01 | 2025-12-31 | No data | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| G20000152752 | HAPPY FRIENDLY SMILES | ACTIVE | 2020-12-01 | 2025-12-31 | No data | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-03-15 |
| ANNUAL REPORT | 2021-04-08 |
| Domestic Profit | 2020-02-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
