| Entity Name: | YOUR KISSIMMEE DENTIST PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 04 Jun 2024 (9 months ago) |
| Document Number: | P24000038758 |
| Address: | 1135 W COLUMBIA AVE, KISSIMMEE,, FL 34741 |
| Mail Address: | 13151 PALOMA DR., ORLANDO, FL 34741 |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750115424 | 2024-08-27 | 2024-08-27 | 13151 PALOMA DR, ORLANDO, FL, 328378723, US | 1135 W COLUMBIA AVE, KISSIMMEE, FL, 347413202, US | |||||||||||||||||
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| Phone | +1 808-407-8085 |
| Phone | +1 407-933-4343 |
| Fax | 4079441434 |
Authorized person
| Name | CARLOS MEDINA |
| Role | DENTIST |
| Phone | 3867175458 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| YOUR MELBOURNE DENTIST PA. | Agent |
| Name | Role | Address |
|---|---|---|
| MEDINA, CARLOS., DMD | Chief Executive Officer | 4326 FLORA VISTA DR, ORLANDO, FL 32837 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-06-04 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
