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COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A. - Florida Company Profile

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Company Details

Entity Name: COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Mar 1997 (28 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 29 Sep 2010 (15 years ago)
Document Number: P97000019233
FEI/EIN Number 593432739
Address: 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652, UN
Mail Address: 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652, UN
ZIP code: 34652
City: New Port Richey
County: Pasco
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MITCHELL MARK President 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
Mehta Uday Vice President 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
Johnston Deon Secretary 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
Young Shaun Director 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
Gibbs III David C Agent 13790 Roosevelt Blvd Suite A, Clearwater, FL, 33762

National Provider Identifier

NPI Number:
1710131826

Authorized Person:

Name:
DR. MARK WAYNE MITCHELL
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary:
Yes

Contacts:

Fax:
7278460755
Fax:
7277259716

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G19000106086 MOSAIC SURGERY ACTIVE 2019-09-27 2030-12-31 - 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
G19000101969 MAXILLOFACIAL SURGICAL ARTS & IMPLANT CENTERS ACTIVE 2019-09-17 2030-12-31 - 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
G19000101975 MOSAIC ACTIVE 2019-09-17 2030-12-31 - 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
G19000101981 MOSAIC - MAXILLOFACIAL SURGICAL ARTS & IMPLANT CENTERS ACTIVE 2019-09-17 2030-12-31 - 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
G17000066205 MAXILLOFACIAL SURGICAL ARTS & IMPLANT CENTERS EXPIRED 2017-06-15 2022-12-31 - 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652
G09089900485 MOSAIC - MITCHELL ORAL SURGERY AND IMPLANT CENTERS ACTIVE 2009-03-30 2029-12-31 - 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2022-02-01 13790 Roosevelt Blvd Suite A, Clearwater, FL 33762 -
REGISTERED AGENT NAME CHANGED 2019-04-02 Gibbs III, David C. -
REINSTATEMENT 2010-09-29 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 - -

Documents

Name Date
ANNUAL REPORT 2025-01-08
ANNUAL REPORT 2024-01-11
ANNUAL REPORT 2023-01-20
ANNUAL REPORT 2022-02-01
ANNUAL REPORT 2021-07-26
AMENDED ANNUAL REPORT 2020-05-28
ANNUAL REPORT 2020-03-17
AMENDED ANNUAL REPORT 2019-04-04
ANNUAL REPORT 2019-04-02
ANNUAL REPORT 2018-01-31

USAspending Awards / Financial Assistance

Date:
2020-05-21
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
150000.00
Total Face Value Of Loan:
150000.00
Date:
2020-05-21
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
150000.00
Total Face Value Of Loan:
150000.00
Date:
2020-04-11
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
368130.00
Total Face Value Of Loan:
368130.00

Paycheck Protection Program

Jobs Reported:
39
Initial Approval Amount:
$368,130
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$368,130
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$370,701.87
Servicing Lender:
Bank of America, National Association
Use of Proceeds:
Payroll: $368,130

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Date of last update: 01 Aug 2025

Sources: Florida Department of State