| Entity Name: | FLORIDA FAMILY DENTISTRY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Oct 1997 (27 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 10 May 2007 (18 years ago) |
| Document Number: | P97000090269 |
| FEI/EIN Number | 593471299 |
| Address: | 4 OLD KINGS RD. N., SUITE A, PALM COAST, FL, 32137 |
| Mail Address: | 4 OLD KINGS RD. N., SUITE A, PALM COAST, FL, 32137 |
| ZIP code: | 32137 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609959428 | 2006-10-23 | 2008-02-27 | 4 OLD KINGS RD N, SUITE A, PALM COAST, FL, 321378226, US | 4 OLD KINGS RD N, SUITE A, PALM COAST, FL, 321378226, US | |||||||||||||||
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| Phone | +1 386-447-1234 |
| Fax | 3864470005 |
Authorized person
| Name | DR. GREGORY A. JOHNSTON |
| Role | PRESIDENT |
| Phone | 3864471234 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FLORIDA FAMILY DENTISTRY 401(K) PLAN | 2023 | 593471299 | 2024-10-03 | FLORIDA FAMILY DENTISTRY, P.A. | 32 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-03 |
| Name of individual signing | CHRISTINA SANTOPADRE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-10-03 |
| Name of individual signing | CHRISTINA SANTOPADRE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 3864451234 |
| Plan sponsor’s address | 4 N. OLD KINGS RD., SUITE A, PALM COAST, FL, 32137 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-10 |
| Name of individual signing | CHRISTINA SANTOPADRE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| RAY TRAVIS E | Agent | 4 OLD KINGS RD. N., PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| RAY TRAVIS E | President | 4 OLD KINGS RD. N. SUITE A, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Hamner Selycette | Treasurer | 4 OLD KINGS RD. N., PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Johnston Jordan S | Vice President | 4 OLD KINGS RD. N., PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Grimes Jonathan B | Secretary | 4 Old Kings Rd. North, Palm Coast, FL, 32137 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G07198900020 | FAMILY DENTISTRY | ACTIVE | 2007-07-17 | 2027-12-31 | No data | 4 OLD KINGS RD. NORTH, SUITE A, PALM COAST, FL, 32137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-01-27 | RAY, TRAVIS E | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-04-20 | 4 OLD KINGS RD. N., SUITE A, PALM COAST, FL 32137 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-20 | 4 OLD KINGS RD. N., SUITE A, PALM COAST, FL 32137 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-04-20 | 4 OLD KINGS RD. N., SUITE A, PALM COAST, FL 32137 | No data |
| AMENDMENT AND NAME CHANGE | 2007-05-10 | FLORIDA FAMILY DENTISTRY, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-06-21 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-14 |
| ANNUAL REPORT | 2016-04-22 |
| ANNUAL REPORT | 2015-04-26 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
