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DENTISTS OF FORT MYERS, PA - Florida Company Profile

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Company Details

Entity Name: DENTISTS OF FORT MYERS, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Jun 2022 (3 years ago)
Document Number: P22000044471
FEI/EIN Number 88-2686225
Address: 5037 SOUTH CLEVELAND AVENUE, SUITE 102, FORT MYERS, FL, 33907-1399
Mail Address: ATTN: LEGAL DEPT, 17000 RED HILL AVENUE, IRVINE, CA, 92614
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Keller Katelyn President 17000 Red Hill Ave., Irvine, CA, 92614
Hussain Faryal Director ATTN: LEGAL DEPT, IRVINE, CA, 92614
Gonzalez Vigon Monica Secretary ATTN: LEGAL DEPT, IRVINE, CA, 92614
Gonzalez Vigon Monica Director ATTN: LEGAL DEPT, IRVINE, CA, 92614
Pham Minh B Chief Financial Officer ATTN: LEGAL DEPT, IRVINE, CA, 92614
Pham Minh B Director ATTN: LEGAL DEPT, IRVINE, CA, 92614
- Agent -

National Provider Identifier

NPI Number:
1598494007
Certification Date:
2022-06-09

Authorized Person:

Name:
MINH B PHAM
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
3039520892
Fax:
2392712073

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000072311 DENTISTS OF FORT MYERS ACTIVE 2022-06-14 2027-12-31 - 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 2024-04-30
ANNUAL REPORT 2023-04-19
Domestic Profit 2022-06-03

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Date of last update: 01 Aug 2025

Sources: Florida Department of State