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BOYNTON MALL MODERN DENTISTRY, PA. - Florida Company Profile

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Company Details

Entity Name: BOYNTON MALL MODERN DENTISTRY, PA.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 10 Jan 2024 (2 years ago)
Document Number: P24000002458
FEI/EIN Number 99-0919619
Mail Address: 17000 RED HILL AVE, IRVINE, CA, 92614, US
Address: 701 N CONGRESS AVE STE 2B, BOYNTON BEACH, FL, 33426, US
ZIP code: 33426
City: Boynton Beach
County: Palm Beach
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Agent -
Pham Minh President 17000 Red Hill Ave., Irvine, CA, 92614
Tolmie Christopher Secretary 17000 Red Hill Ave., Irvine, CA, 92614
Ghazal Carolyn Director 17000 Red Hill Ave., Irvine, CA, 92614

National Provider Identifier

NPI Number:
1386401495
Certification Date:
2024-03-05

Authorized Person:

Name:
CHRISTOPHER K TOLMIE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
5612284066

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000021173 BOYNTON MALL MODERN DENTISTRY ACTIVE 2024-02-07 2029-12-31 - 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614

Documents

Name Date
Domestic Profit 2024-01-10

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Date of last update: 03 Aug 2025

Sources: Florida Department of State