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WILDWOOD MODERN DENTISTRY, PA - Florida Company Profile

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Company Details

Entity Name: WILDWOOD MODERN DENTISTRY, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Jan 2025 (8 months ago)
Document Number: P25000000109
Mail Address: 17000 RED HILL AVENUE, IRVINE, CA, 92614
Address: 5297 SUNDANCE TRL, WILDWOOD, FL, 34785, US
ZIP code: 34785
City: Wildwood
County: Sumter
Place of Formation: FLORIDA

Key Officers & Management

Role
Agent

National Provider Identifier

NPI Number:
1063222149
Certification Date:
2025-01-10

Authorized Person:

Name:
JERIN JOSEPH
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000003027 WILDWOOD MODERN DENTISTRY ACTIVE 2025-01-07 2030-12-31 - 17000 RED HILL AVENUE, ATTENTION: LEGAL DEPARTMENT, IRVINE, CA, 92614

Documents

Name Date
Domestic Profit 2025-01-02

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Date of last update: 03 Aug 2025

Sources: Florida Department of State