| Entity Name: | FORT MYERS MODERN DENTISTRY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 07 May 2024 (9 months ago) |
| Document Number: | P24000031610 |
| Address: | 3330 FORUM BLVD., FORT MYERS, FL 33905 |
| Mail Address: | ATTN: LEGAL DEPARTMENT, 17000 RED HILL AVENUE, IRVINE, CA 92614 |
| ZIP code: | 33905 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245088319 | 2024-05-13 | 2024-06-11 | PO BOX 920050, DALLAS, TX, 753920050, US | 3330 FORUM BLVD, FORT MYERS, FL, 339055578, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 239-241-9128 |
Authorized person
| Name | KELSEY ARCHER |
| Role | OWNER |
| Phone | 7148458500 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000061598 | FORT MYERS MODERN DENTISTRY | ACTIVE | 2024-05-10 | 2029-12-31 | No data | 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-05-07 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
