| Entity Name: | COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| 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
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652, UN |
| Mail Address: | 6731 MADISON STREET, NEW PORT RICHEY, FL, 34652, UN |
| ZIP code: | 34652 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710131826 | 2008-11-17 | 2008-11-17 | 6731 MADISON ST, NEW PORT RICHEY, FL, 346521928, US | 2720 PARK DR, CLEARWATER, FL, 337631020, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 727-842-5180 |
| Fax | 7278460755 |
| Phone | +1 727-726-8500 |
| Fax | 7277259716 |
Authorized person
| Name | DR. MARK WAYNE MITCHELL |
| Role | PRESIDENT |
| Phone | 7278425180 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | DN10802 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 072932900 |
| State | FL |
| 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 |
| 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 |
| 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 | - | - |
| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2734597103 | 2020-04-11 | 0455 | PPP | 6731 MADISON ST, NEW PORT RICHEY, FL, 34652-1928 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of last update: 02 Apr 2025
Sources: Florida Department of State
