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DEERFIELD MODERN DENTISTRY, PA - Florida Company Profile

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Company Details

Entity Name: DEERFIELD MODERN DENTISTRY, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 23 Mar 2020 (5 years ago)
Document Number: P20000025037
FEI/EIN Number 85-0544449
Address: 778 S FEDERAL HWY, DEERFIELD BEACH, FL, 33441
Mail Address: ATTN:LEGAL DEPARTMENT, 17000 RED HILL AVENUE, IRVING, CA, 92614
ZIP code: 33441
City: Deerfield Beach
County: Broward
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Agent -
Pham Minh B Director ATTN:LEGAL DEPARTMENT, IRVING, CA, 92614
Azadi Anthony A Director ATTN:LEGAL DEPARTMENT, IRVING, CA, 92614
Gonzales Nathaniel A Director ATTN:LEGAL DEPARTMENT, IRVING, CA, 92614
Azadi Anthony A President ATTN:LEGAL DEPARTMENT, IRVING, CA, 92614
Gonzales, Nathaniel S Secretary ATTN:LEGAL DEPARTMENT, IRVING, CA, 92614
Pham Minh B Treasurer ATTN:LEGAL DEPARTMENT, IRVING, CA, 92614

National Provider Identifier

NPI Number:
1790393890
Certification Date:
2022-06-14

Authorized Person:

Name:
ANTHONY AZADI
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
3039520892
Fax:
7543334026

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000079987 DEERFIELD MODERN DENTISTRY ACTIVE 2020-07-08 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 2024-04-16
ANNUAL REPORT 2023-04-14
ANNUAL REPORT 2022-02-22
Reg. Agent Change 2021-12-06
ANNUAL REPORT 2021-04-07
Domestic Profit 2020-03-23

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Date of last update: 03 Aug 2025

Sources: Florida Department of State