| Entity Name: | JUAN GUILLERMO LOPEZ DMD, DDS, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Nov 2021 (3 years ago) |
| Document Number: | P21000095797 |
| FEI/EIN Number | 87-3539591 |
| Address: | 13300-46 S CLEVELAND AVE, FORT MYERS, FL, 33907, US |
| Mail Address: | 13300-46 S CLEVELAND AVE, FORT MYERS, FL, 33907, US |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124745740 | 2022-10-24 | 2022-10-24 | 13300 S CLEVELAND AVE STE 46, FORT MYERS, FL, 339073883, US | 13300 S CLEVELAND AVE STE 46, FORT MYERS, FL, 339073883, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-768-1011 |
| Fax | 2397689311 |
Authorized person
| Name | DR. JUAN GUILLERMO LOPEZ |
| Role | OWNER |
| Phone | 2397681011 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | No |
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DENTAL LICENSE |
| Number | DN17696 |
| State | FL |
| Issuer | NPI 1 |
| Number | 1447281720 |
| State | FL |
| Name | Role |
|---|---|
| CALIMA DENTAL MANAGEMENT, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| LOPEZ JUAN GUILLERMODMD | President | 13300-46 S CLEVELAND AVE, FORT MYERS, FL, 33907 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000020517 | CALIMA DENTAL CARE | ACTIVE | 2022-01-25 | 2027-12-31 | No data | 13300-46 S CLEVELAND AVENUE, FORT MYERS, FL, 33907 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-03-18 |
| ANNUAL REPORT | 2022-04-27 |
| Domestic Profit | 2021-11-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
