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ALFONSO CRUZ, DMD, P.A. - Florida Company Profile

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Company Details

Entity Name: ALFONSO CRUZ, DMD, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 19 May 2021 (4 years ago)
Document Number: P21000047195
FEI/EIN Number 86-3802579
Address: 1657 Taylor Road Ste 106, PORT ORANGE, FL, 32128, US
Mail Address: 1657 Taylor Road Ste 106, PORT ORANGE, FL, 32128, US
ZIP code: 32128
City: Port Orange
County: Volusia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CRUZ ALFONSO President 6602 MERRYVALE LANE, PORT ORANGE, FL, 32128
CRUZ ALFONSO Secretary 6602 MERRYVALE LANE, PORT ORANGE, FL, 32128
MCMAHON GREGORY PESQ Agent 618 E SOUTH STREET, ORLANDO, FL, 32801

National Provider Identifier

NPI Number:
1730826249
Certification Date:
2022-05-16

Authorized Person:

Name:
DR. ALFONSO CRUZ
Role:
DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000073170 CREEK FAMILY DENTAL ACTIVE 2022-06-16 2027-12-31 - 1657 TAYLOR ROAD, STE 106, PORT ORANGE, FL, 32128

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-07-29 1657 Taylor Road Ste 106, PORT ORANGE, FL 32128 -
CHANGE OF MAILING ADDRESS 2022-07-29 1657 Taylor Road Ste 106, PORT ORANGE, FL 32128 -

Documents

Name Date
ANNUAL REPORT 2025-01-16
ANNUAL REPORT 2024-01-06
ANNUAL REPORT 2023-01-12
ANNUAL REPORT 2022-01-26
Domestic Profit 2021-05-19

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Date of last update: 02 Aug 2025

Sources: Florida Department of State