| Entity Name: | SILVER LAKES DENTAL ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Oct 1995 (29 years ago) |
| Document Number: | P95000076054 |
| FEI/EIN Number | 650614225 |
| Address: | 17792 SW 2ND STREET, PEMBROKE PINES, FL, 33029 |
| Mail Address: | 17792 SW 2ND ST, PEMBROKE PINES, FL, 33029 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801013339 | 2007-04-19 | 2008-08-07 | 17792 SW 2ND ST, PEMBROKE PINES, FL, 330293923, US | 17792 SW 2ND ST, PEMBROKE PINES, FL, 330293923, US | |||||||||||||||||||
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| Phone | +1 954-435-2999 |
| Fax | 9544350011 |
Authorized person
| Name | DR. KEITH MARLOWE FRIEFELD |
| Role | PRESIDENT |
| Phone | 9544352999 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN11976 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FRIEFELD SHELDON | Agent | 7533 HAWKS LANDING DRIVE, WEST PALM BEACH, FL, 33412 |
| Name | Role | Address |
|---|---|---|
| FRIEFELD KEITH M | Director | 16843 Pavilion Way, Delray Beach, FL, 33446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1996-02-29 | SILVER LAKES DENTAL ASSOCIATES, P.A. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
