| Entity Name: | JEREMIAH D. PATRICK, D.M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Jun 2021 (4 years ago) |
| Document Number: | P21000056611 |
| FEI/EIN Number | 87-1227225 |
| Address: | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL 32548 |
| Mail Address: | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL 32548 |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154096097 | 2021-08-12 | 2023-04-25 | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL, 32548, US | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL, 32548, US | |||||||||||||||
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| Phone | +1 850-243-7977 |
| Fax | 8502441860 |
Authorized person
| Name | DR. JEREMIAH DANIEL PATRICK |
| Role | CEO |
| Phone | 8502437977 |
Taxonomy
| Taxonomy Code | 1223E0200X - Endodontist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Patrick, Jeremiah D., D.M.D. | Agent | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL 32548 |
| Name | Role | Address |
|---|---|---|
| PATRICK, JEREMIAH D., D.M.D. | Chief Executive Officer | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL 32548 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000160481 | PATRICK ENDODONTICS | ACTIVE | 2021-12-03 | 2026-12-31 | No data | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL, 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-01-19 | Patrick, Jeremiah D., D.M.D. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-19 | 9 YACHT CLUB DRIVE NE, FORT WALTON BEACH, FL 32548 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-10 |
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-04-03 |
| Domestic Profit | 2021-06-16 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
