| Entity Name: | KIDS DENTAL PLUS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Jun 2021 (4 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 12 Aug 2021 (4 years ago) |
| Document Number: | P21000059592 |
| FEI/EIN Number | 87-1896728 |
| Address: | 2910 N. STATE ROAD 7, LAUDERDALE LAKES, FL, 33331, US |
| Mail Address: | 2910 N. STATE ROAD 7, LAUDERDALE LAKES, FL, 33331, US |
| ZIP code: | 33331 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528722436 | 2021-10-26 | 2021-11-01 | 2910 N STATE ROAD 7, LAUDERDALE LAKES, FL, 333131912, US | 2910 N STATE ROAD 7, LAUDERDALE LAKES, FL, 333131912, US | |||||||||||||||||||||
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| Phone | +1 954-533-9639 |
| Fax | 9543684316 |
Authorized person
| Name | DR. RUBEN VILLARREAL |
| Role | DENTIST |
| Phone | 9545339639 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021266000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STESZWESKI JONATHAN ESQ. | Agent | 15100 NW 67TH AVE, SUITE 200, MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| VILLARREAL RUBEN D | President | 2910 N. STATE ROAD 7, LAUDERDALE LAKES, FL, 33331 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2021-08-12 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-01-21 |
| Amendment | 2021-08-12 |
| Domestic Profit | 2021-06-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
