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LAKE BUTLER DENTAL GROUP, PA - Florida Company Profile

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Company Details

Entity Name: LAKE BUTLER DENTAL GROUP, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Dec 2022 (3 years ago)
Document Number: P22000088883
FEI/EIN Number 92-1299085
Mail Address: 17000 RED HILL AVENUE, IRVINE, CA, 92614, US
Address: 4014 WINTER GARDEN VINELAND ROAD, SUITE B, WINTER GARDEN, FL, 34787, US
ZIP code: 34787
City: Winter Garden
County: Orange
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Peters-Seppala, Lisa President 17000 RED HILL AVENUE, IRVINE, CA, 92614
Nam Sung M Secretary 17000 RED HILL AVENUE, IRVINE, CA, 92614
Pham Minh B Chief Financial Officer 17000 RED HILL AVENUE, IRVINE, CA, 92614
Peters-Seppala Lisa Director 17000 RED HILL AVENUE, IRVINE, CA, 92614
Pham Minh B Director 17000 RED HILL AVENUE, IRVINE, CA, 92614
Nam Sung Director 17000 RED HILL AVENUE, IRVINE, CA, 92614
- Agent -

National Provider Identifier

NPI Number:
1124732698
Certification Date:
2023-01-06

Authorized Person:

Name:
MINH PHAM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3214188920

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000153320 LAKE BUTLER DENTAL GROUP ACTIVE 2022-12-13 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 2024-04-16
ANNUAL REPORT 2023-04-17
Domestic Profit 2022-12-02

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Date of last update: 02 Aug 2025

Sources: Florida Department of State