| Entity Name: | LAKE BUTLER DENTAL GROUP, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Dec 2022 (2 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 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124732698 | 2023-01-10 | 2023-01-10 | PO BOX 920050, DALLAS, TX, 753920050, US | 4014 WINTER GARDEN VINELAND ROAD, SUITE B, WINTER GARDEN, FL, 34787, US | |||||||||||||||
|
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| Phone | +1 321-248-2923 |
| Fax | 3214188920 |
Authorized person
| Name | MINH PHAM |
| Role | OWNER |
| Phone | 3212482923 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Peters-Seppala, Lisa | President | 17000 RED HILL AVENUE, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Nam Sung M | Secretary | 17000 RED HILL AVENUE, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| Pham Minh B | Chief Financial Officer | 17000 RED HILL AVENUE, IRVINE, CA, 92614 |
| Name | Role | Address |
|---|---|---|
| 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 |
| 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 | No data | 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-06-13 | 115 N. CALHOUN ST., STE 4, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-17 |
| Domestic Profit | 2022-12-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
