| Entity Name: | DERMATOLOGY, ENID F. BURNETT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 15 Oct 1998 (26 years ago) |
| Date of dissolution: | 16 Sep 2005 (19 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 16 Sep 2005 (19 years ago) |
| Document Number: | P98000088179 |
| FEI/EIN Number | 593536402 |
| Mail Address: | 339-A BILL FRANCE BLVD., DAYTONA BEACH, FL, 32114 |
| Address: | 389A BELL FRANCE BLVD., DAYTONA BEACH, FL, 32114 |
| ZIP code: | 32114 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699945626 | 2008-03-05 | 2008-07-03 | 339A BILL FRANCE BLVD, DAYTONA BEACH, FL, 321141301, US | 339A BILL FRANCE BLVD, DAYTONA BEACH, FL, 321141301, US | |||||||||||||||||
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| Phone | +1 386-253-2216 |
Authorized person
| Name | DR. ENID F BURNETT |
| Role | DOCTOR |
| Phone | 3862532070 |
Taxonomy
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| License Number | ME0072841 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DERMATOLOGY ENID F BURNETT INC 401 K PROFIT SHARING PLAN TRUST | 2010 | 593536402 | 2011-07-26 | DERMATOLOGY ENID F BURNETT INC | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 593536402 |
| Plan administrator’s name | DERMATOLOGY ENID F BURNETT INC |
| Plan administrator’s address | 339A BELL FRANCE BLVD, DAYTONA BEACH, FL, 32114 |
| Administrator’s telephone number | 3862532070 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-26 |
| Name of individual signing | DERMATOLOGY ENID F BURNETT INC |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BURNETT ENID F | Agent | 339-A BILL FRANCE BLVD., DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| BURNETT ENID FMD | President | 339-A BILL FRANCE BLVD., DAYTONA BCH, FL, 32114 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-01-23 | 389A BELL FRANCE BLVD., DAYTONA BEACH, FL 32114 | No data |
| CHANGE OF MAILING ADDRESS | 2001-07-31 | 389A BELL FRANCE BLVD., DAYTONA BEACH, FL 32114 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2001-07-31 | 339-A BILL FRANCE BLVD., DAYTONA BEACH, FL 32114 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2004-01-23 |
| ANNUAL REPORT | 2003-02-21 |
| ANNUAL REPORT | 2002-02-24 |
| ANNUAL REPORT | 2001-07-31 |
| ANNUAL REPORT | 2000-02-11 |
| ANNUAL REPORT | 1999-03-16 |
| Domestic Profit | 1998-10-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
