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SUNSHINE STATE DENTAL GROUP, P.A. - Florida Company Profile

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Company Details

Entity Name: SUNSHINE STATE DENTAL GROUP, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 21 Aug 2024 (a year ago)
Document Number: P24000054261
FEI/EIN Number APPLIED FOR
Address: 374 N CONGRESS AVE, BOYNTON BEACH, FL, 33426, US
Mail Address: 374 N CONGRESS AVE, BOYNTON BEACH, FL, 33426, US
ZIP code: 33426
City: Boynton Beach
County: Palm Beach
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
KHOSHROU BITA President 374 N CONGRESS AVE, BOYNTON BEACH, FL, 33426
EWING JONATHAN AESQ Agent 1100 LEE WAGENER BLVD, FORT LAUDERDALE, FL, 33315

National Provider Identifier

NPI Number:
1316753833
Certification Date:
2024-12-09

Authorized Person:

Name:
MS. VERONICA VANESA SILVA
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
5616834996

Documents

Name Date
Domestic Profit 2024-08-21

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Date of last update: 01 Aug 2025

Sources: Florida Department of State