| Entity Name: | GEORGINA MESA, D.M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 12 Jun 1995 (30 years ago) |
| Document Number: | P95000045111 |
| FEI/EIN Number | 65-0603630 |
| Address: | 13550 SW 120th ST, SUITE 512, MIAMI, FL 33186 |
| Mail Address: | 16527 S.W. 90 STREET, MIAMI, FL 33196 |
| ZIP code: | 33186 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770997876 | 2014-06-17 | 2014-06-17 | 13550 SW 120TH ST, SUITE 512, MIAMI, FL, 331867397, US | 1878 SW 57TH AVE, MIAMI, FL, 331552139, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-380-7000 |
| Fax | 7862275315 |
| Phone | +1 305-262-9299 |
| Fax | 3052628772 |
Authorized person
| Name | GEORGINA MESA |
| Role | PRESIDENT |
| Phone | 3053807000 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN0013428 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075011500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MUNOZ, PETER | Agent | 16527 SW 90 STREET, MIAMI, FL 33196 |
| Name | Role | Address |
|---|---|---|
| MESA, GEORGINA D.M.D. | President | 16527 S.W. 90 STREET, MIAMI, FL 33193 |
| Name | Role | Address |
|---|---|---|
| MESA, GEORGINA D.M.D. | Vice President | 16527 S.W. 90 STREET, MIAMI, FL 33193 |
| Name | Role | Address |
|---|---|---|
| MESA, GEORGINA D.M.D. | Secretary | 16527 S.W. 90 STREET, MIAMI, FL 33193 |
| Name | Role | Address |
|---|---|---|
| MESA, GEORGINA D.M.D. | Treasurer | 16527 S.W. 90 STREET, MIAMI, FL 33193 |
| Name | Role | Address |
|---|---|---|
| MESA, GEORGINA D.M.D. | Director | 16527 S.W. 90 STREET, MIAMI, FL 33193 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-06 | 13550 SW 120th ST, SUITE 512, MIAMI, FL 33186 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-02-18 | MUNOZ, PETER | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-02-18 | 16527 SW 90 STREET, MIAMI, FL 33196 | No data |
| CHANGE OF MAILING ADDRESS | 1998-04-27 | 13550 SW 120th ST, SUITE 512, MIAMI, FL 33186 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-04-06 |
| ANNUAL REPORT | 2015-04-28 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1236207203 | 2020-04-15 | 0455 | PPP | 16527 SW 90TH ST, MIAMI, FL, 33196-1013 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
