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  5. PALM BEACH ENDODONTICS, P.A.

PALM BEACH ENDODONTICS, P.A.

Company Details

Entity Name: PALM BEACH ENDODONTICS, P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 07 Aug 1998 (27 years ago)
Document Number: P98000069071
FEI/EIN Number 65-0862462
Address: 11211 PROSPERITY FARMS RD., B107, PALM BEACH GARDENS, FL 33410
Mail Address: 11211 PROSPERITY FARMS RD., B107, PALM BEACH GARDENS, FL 33410
ZIP code: 33410
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1740431980 2008-10-07 2008-10-07 11211 PROSPERITY FARMS RD, SUITE B107, PALM BEACH GARDENS, FL, 334103446, US 11211 PROSPERITY FARMS RD, SUITE B107, PALM BEACH GARDENS, FL, 334103446, US

Contacts
Phone +1 561-630-8900
Fax 5616308909

Authorized person
Name DR. KENNETH W. BRADSHAW
Role PRESIDENT
Phone 5616308900

Taxonomy
Taxonomy Code 1223E0200X - Endodontist
License Number DN13872
State FL
Is Primary Yes
Taxonomy Code 1223E0200X - Endodontist
License Number DN16549
State FL
Is Primary No
Taxonomy Code 1223E0200X - Endodontist
License Number DN13841
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2023 650862462 2024-09-20 PALM BEACH ENDODONTICS, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE B107, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2024-09-20
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-20
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2022 650862462 2023-10-11 PALM BEACH ENDODONTICS, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE B107, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-11
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2021 650862462 2022-10-16 PALM BEACH ENDODONTICS, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE B107, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2022-10-16
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-16
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2020 650862462 2021-07-19 PALM BEACH ENDODONTICS, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE B107, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2021-07-19
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-19
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2019 650862462 2020-07-30 PALM BEACH ENDODONTICS, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2020-07-30
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-30
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2018 650862462 2019-08-23 PALM BEACH ENDODONTICS, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2019-08-23
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-08-23
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2017 650862462 2018-07-24 PALM BEACH ENDODONTICS, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE B107, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2018-07-24
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-24
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
PALM BEACH ENDODONTICS, P.A. 401(K) PROFIT SHARING PLAN & TRUST 2016 650862462 2017-10-02 PALM BEACH ENDODONTICS, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5618334633
Plan sponsor’s address 11211 PROSPERITY FARMS ROAD, SUITE B107, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2017-10-02
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-02
Name of individual signing KENNETH BRADSHAW
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BRADSHAW, KENNETH JR. Agent 11211 PROSPERITY FARMS RD., B107, PALM BEACH GARDENS, FL 33410

President

Name Role Address
BRADSHAW, KENNETH W President 11211 PROSPERITY FARMS RD. , B107, PALM BEACH GARDENS, FL 33410

Vice President

Name Role Address
BRADSHAW, CHARLYN R Vice President 11211 PROSPERITY FARMS RD. , B107, PALM BEACH GARDENS, FL 33410

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2005-07-01 11211 PROSPERITY FARMS RD., B107, PALM BEACH GARDENS, FL 33410 No data
CHANGE OF MAILING ADDRESS 2005-07-01 11211 PROSPERITY FARMS RD., B107, PALM BEACH GARDENS, FL 33410 No data
REGISTERED AGENT ADDRESS CHANGED 2005-07-01 11211 PROSPERITY FARMS RD., B107, PALM BEACH GARDENS, FL 33410 No data

Documents

Name Date
ANNUAL REPORT 2024-01-28
ANNUAL REPORT 2023-01-21
ANNUAL REPORT 2022-01-29
ANNUAL REPORT 2021-01-11
ANNUAL REPORT 2020-01-18
ANNUAL REPORT 2019-04-07
ANNUAL REPORT 2018-01-14
ANNUAL REPORT 2017-04-16
ANNUAL REPORT 2016-02-19
ANNUAL REPORT 2015-01-11

Related by officers

BRADSHAW, KENNETH W

METZGER INSURANCE AGENCY, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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