| Entity Name: | SAGE DENTAL OF LAKE WORTH, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Jul 1998 (27 years ago) |
| Document Number: | P98000060073 |
| FEI/EIN Number | 650847884 |
| Address: | 6600 Congress Avenue, BOCA RATON, FL, 33487, US |
| Mail Address: | 6600 Congress Avenue, BOCA RATON, FL, 33487, US |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316142037 | 2007-06-21 | 2017-03-17 | 951 BROKEN SOUND PKWY, SUITE 250, BOCA RATON, FL, 33487, US | 1922 LAKE WORTH RD, LAKE WORTH, FL, 334614228, US | |||||||||||||||||||||
|
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| Phone | +1 561-999-9650 |
| Fax | 5614318169 |
| Phone | +1 561-547-5597 |
Authorized person
| Name | ANTONIO CRUZ |
| Role | CHIEF DENTAL DIRECTOR |
| Phone | 5619999650 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN6483 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CT Corporation System | Agent | 1200 South Pine Island Road, Plantation, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| ROARK CINDY | President | 6600 Congress Avenue, BOCA RATON, FL, 33487 |
| Name | Role |
|---|---|
| SAGE DENTAL GROUP OF FLORIDA, PLLC | Othe |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000033875 | GENTLE DENTAL | EXPIRED | 2016-04-04 | 2021-12-31 | No data | 951 BROKEN SOUND PARKWAY, SUITE 250, BOCA RATON, FL, 33487 |
| G15000030738 | GENTLE DENTAL | EXPIRED | 2015-03-25 | 2020-12-31 | No data | 951 BROKEN SOUND PARKWAY, SUITE 250, BOCA RATON, FL, 33487 |
| G15000030749 | SAGE DENTAL | ACTIVE | 2015-03-25 | 2025-12-31 | No data | 951 BROKEN SOUND PARKWAY, SUITE 250, BOCA RATON, FL, 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2019-12-18 | No data | No data |
| NAME CHANGE AMENDMENT | 2015-07-14 | SAGE DENTAL OF LAKE WORTH, P.A. | No data |
| NAME CHANGE AMENDMENT | 2015-06-02 | SAGE DENTAL OF LAKE WORTH, P.A. | No data |
| AMENDMENT AND NAME CHANGE | 1999-03-11 | GENTLE DENTAL GROUP OF LAKE WORTH, P.A. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
