| Entity Name: | DAO-NGUYEN DMD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 May 2023 (2 years ago) |
| Document Number: | P23000035592 |
| FEI/EIN Number | 92-3974833 |
| Address: | 39863 US Hwy 27, Davenport, FL, 33897, US |
| Mail Address: | 39863 US Hwy 27, Davenport, FL, 33897, US |
| ZIP code: | 33897 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114798246 | 2024-01-09 | 2024-03-01 | 39863 HIGHWAY 27, DAVENPORT, FL, 338377802, US | 39863 HIGHWAY 27, DAVENPORT, FL, 338377802, US | |||||||||||||||||||||||||||
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| Phone | +1 863-216-3369 |
| Fax | 8632163368 |
Authorized person
| Name | ANNA DAO |
| Role | PROVIDER |
| Phone | 8632163369 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1043986359 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1134744477 |
| State | MO |
| Name | Role | Address |
|---|---|---|
| Dao Anna | Agent | 13133 ZORI LANE, WINDERMERE, FL, 34786 |
| Name | Role | Address |
|---|---|---|
| DAO ANNA DMD | President | 13133 ZORI LANE, WINDERMERE, FL, 34786 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000010386 | ZENITH DENTAL | ACTIVE | 2024-01-17 | 2029-12-31 | No data | 39863 US HWY 27, DAVENPORT, FL, 33897 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-05 | 39863 US Hwy 27, Davenport, FL 33897 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-05 | 39863 US Hwy 27, Davenport, FL 33897 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-17 | Dao, Anna | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-17 | 13133 ZORI LANE, WINDERMERE, FL 34786 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-17 |
| Domestic Profit | 2023-05-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
