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CLERMONT MODERN DENTISTRY, PA - Florida Company Profile

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Company Details

Entity Name: CLERMONT MODERN DENTISTRY, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 20 Oct 2021 (4 years ago)
Document Number: P21000091047
FEI/EIN Number 87-3230141
Mail Address: 17000 RED HILL AVE, IRVINE, CA, 92614, US
Address: 17300 STATE RD 50, CLERMONT, FL, 34711, US
ZIP code: 34711
City: Clermont
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Agent -
Nam Sung M Treasurer 17000 RED HILL AVE, IRVINE, CA, 92614
Pham Minh B Director 17000 RED HILL AVE, IRVINE, CA, 92614
Nathoo Pritesh H Director 17000 RED HILL AVE, IRVINE, CA, 92614
Pham Minh B Secretary 17000 RED HILL AVE, IRVINE, CA, 92614
Pham Minh President 17000 RED HILL AVE, IRVINE, CA, 92614
Peters-Seppala Lisa Director 17000 RED HILL AVE, IRVINE, CA, 92614

National Provider Identifier

NPI Number:
1548925902
Certification Date:
2021-11-01

Authorized Person:

Name:
DR. MINH PHAM
Role:
OWNER DENTIST
Phone:

Taxonomy:

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

Contacts:

Fax:
3039520892
Fax:
3524158365

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G21000143897 CLERMONT MODERN DENTISTRY ACTIVE 2021-10-26 2026-12-31 - 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 2024-04-17
ANNUAL REPORT 2023-04-17
ANNUAL REPORT 2022-03-18
Domestic Profit 2021-10-20

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Date of last update: 03 Aug 2025

Sources: Florida Department of State