| Entity Name: | LAKE DENTAL SERVICES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 06 Sep 1995 (29 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 22 May 2002 (23 years ago) |
| Document Number: | P95000068759 |
| FEI/EIN Number | 593337224 |
| Mail Address: | 6240 LAKE OSPREY DR., SARASOTA, FL, 34240, US |
| Address: | 820 STATE RD 434 N., STE B, ALTAMONTE SPRINGS, FL, 32714, US |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255444634 | 2006-08-17 | 2014-08-21 | 13195 SW 134 ST, 2ND FLOOR, MIAMI, FL, 33186, US | 820 STATE RD. 434 N., SUITE B, ALTAMONTE SPRINGS, FL, 32714, US | |||||||||||||||||||
|
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| Phone | +1 305-274-2499 |
| Phone | +1 407-865-9100 |
Authorized person
| Name | STEPHANIE GOMEZ |
| Role | PROVIDER RELATIONS |
| Phone | 3052742499 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | No |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| GALLO DONALD | Director | 6240 Lake Osprey Dr., Sarasota, FL, 34240 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000123645 | TOWNCARE DENTAL OF ALTAMONTE SPRINGS | ACTIVE | 2024-10-03 | 2029-12-31 | No data | 6240 LAKE OSPREY DRIVE, SARASOTA, FL, 34240 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-25 | 820 STATE RD 434 N., STE B, ALTAMONTE SPRINGS, FL 32714 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-25 | 820 STATE RD 434 N., STE B, ALTAMONTE SPRINGS, FL 32714 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-25 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-25 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| AMENDMENT AND NAME CHANGE | 2002-05-22 | LAKE DENTAL SERVICES, INC. | No data |
| AMENDMENT AND NAME CHANGE | 1995-10-13 | LAKE DENTAL SERVICES, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| Reg. Agent Change | 2024-04-25 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-03-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
