| Entity Name: | A. TINA CHANDRA, D.D.S., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Aug 1999 (26 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 04 Dec 2007 (17 years ago) |
| Document Number: | P99000072103 |
| FEI/EIN Number | 593606079 |
| Address: | 1920 SW 20 PLACE, SUITE 202, OCALA, FL, 34471 |
| Mail Address: | 1920 SW 20 PLACE, SUITE 202, OCALA, FL, 34471 |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841617438 | 2014-03-21 | 2018-10-24 | 1920 SW 20TH PL, SUITE 202, OCALA, FL, 344717881, US | 1920 SW 20TH PL, SUITE 202, OCALA, FL, 344717881, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-861-1500 |
| Fax | 3528611507 |
Authorized person
| Name | RENEE M CUSTER |
| Role | OFFICE ADMINISTRATOR |
| Phone | 3528611500 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN14503 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NATIONAL PROVIDER IDENTIFICATION |
| Number | 1174669485 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHANDRA A TINA | Agent | 1920 SW 20 PLACE, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| CHANDRA A TINA | Director | 1920 SW 20 PLACE SUITE 202, OCALA, FL, 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CANCEL ADM DISS/REV | 2007-12-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-12-04 | 1920 SW 20 PLACE, SUITE 202, OCALA, FL 34471 | No data |
| CHANGE OF MAILING ADDRESS | 2007-12-04 | 1920 SW 20 PLACE, SUITE 202, OCALA, FL 34471 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-12-04 | 1920 SW 20 PLACE, SUITE 202, OCALA, FL 34471 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-02-18 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
