| Entity Name: | VIVIAN MEDINA, D.D.S. PA. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Jan 1993 (32 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 08 Feb 2010 (15 years ago) |
| Document Number: | P93000020978 |
| FEI/EIN Number | 593196721 |
| Address: | 3630 MADACA LN, TAMPA, FL, 33618, US |
| Mail Address: | 3630 MADACA LN, TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316295223 | 2012-08-27 | 2012-08-27 | 3630 MADACA LN, TAMPA, FL, 336182057, US | 3630 MADACA LN, TAMPA, FL, 336182057, US | |||||||||||||||||||
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| Phone | +1 813-264-0286 |
| Fax | 8139604667 |
Authorized person
| Name | DR. VIVIAN MEDINA |
| Role | OWNER |
| Phone | 8132640286 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN12750 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MEDINA VIVIAN | Agent | 3630 Madaca Lane, TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| MEDINA VIVIAN | President | 3630 MADACA LANE, TAMPA, FL, 33618 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-06 | 3630 Madaca Lane, TAMPA, FL 33618 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-17 | 3630 MADACA LN, TAMPA, FL 33618 | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-17 | 3630 MADACA LN, TAMPA, FL 33618 | No data |
| CANCEL ADM DISS/REV | 2010-02-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2004-07-16 | VIVIAN MEDINA, D.D.S. PA. | No data |
| REGISTERED AGENT NAME CHANGED | 2004-07-16 | MEDINA, VIVIAN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-11 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-02-06 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
