| Entity Name: | FAMILY DENTAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 13 May 1991 (34 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | S52521 |
| FEI/EIN Number | 59-3067872 |
| Address: | 2727 W. M.L. KING JR. BLVD., SUITE 120, TAMPA, FL 33607 |
| Mail Address: | 2727 W. M.L. KING JR. BLVD., SUITE 120, TAMPA, FL 33607 |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790825289 | 2007-02-07 | 2011-12-01 | 2727 W DR MARTIN LUTHER KING JR BLVD STE 120, TAMPA, FL, 336076353, US | 2727 W DR MARTIN LUTHER KING JR BLVD STE 120, TAMPA, FL, 336076353, US | |||||||||||||||||||||||||
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| Phone | +1 813-873-9100 |
| Fax | 8138739176 |
Authorized person
| Name | DR. NATHAN A GRADDY |
| Role | PRESIDENT DENTIST |
| Phone | 8132210010 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DN4964 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 072704100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRADDY, NATHAN | Agent | 2727 W. MARTIN LUTHER KING BLVD., SUITE 120, TAMPA, FL 33607 |
| Name | Role | Address |
|---|---|---|
| GRADDY, NATHAN | President | 4819 CHEVAL BLVD, LUTZ, FL 33558 |
| Name | Role | Address |
|---|---|---|
| BUCHANAN, MARLENE | Secretary | 4819 CHEVAL BLVD, LUTZ, FL 33558 |
| Name | Role | Address |
|---|---|---|
| BUCHANAN, MARLENE | Treasurer | 4819 CHEVAL BLVD, LUTZ, FL 33558 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-13 | 2727 W. M.L. KING JR. BLVD., SUITE 120, TAMPA, FL 33607 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-13 | 2727 W. M.L. KING JR. BLVD., SUITE 120, TAMPA, FL 33607 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-13 | 2727 W. MARTIN LUTHER KING BLVD., SUITE 120, TAMPA, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-03-22 |
| ANNUAL REPORT | 2014-03-04 |
| ANNUAL REPORT | 2013-03-04 |
| ANNUAL REPORT | 2012-04-13 |
| ANNUAL REPORT | 2011-03-08 |
| ANNUAL REPORT | 2010-06-24 |
| ANNUAL REPORT | 2009-06-17 |
| ANNUAL REPORT | 2008-04-25 |
| ANNUAL REPORT | 2007-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
