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COUNTRYSIDE DENTAL, P.C.

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Company Details

Name: COUNTRYSIDE DENTAL, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 19 May 2003 (22 years ago)
Entity Number: 2907999
ZIP code: 12037
County: Columbia
Place of Formation: New York
Address: 42 KINDERHOOK ST, CHATHAM, NY, United States, 12037

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 42 KINDERHOOK ST, CHATHAM, NY, United States, 12037

Chief Executive Officer

Name Role Address
DR DOMENIC RICCOBONO Chief Executive Officer 42 KINDERHOOK ST, CHATHAM, NY, United States, 12037

National Provider Identifier

NPI Number:
1952558074

Authorized Person:

Name:
DR. DOMENIC RICCOBONO
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
No
Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
5183927339

Form 5500 Series

Employer Identification Number (EIN):
200052565
Plan Year:
2012
Number Of Participants:
17
Sponsors Telephone Number:

Filings

Filing Number Date Filed Type Effective Date
190501060753 2019-05-01 BIENNIAL STATEMENT 2019-05-01
180116006339 2018-01-16 BIENNIAL STATEMENT 2017-05-01
130517006270 2013-05-17 BIENNIAL STATEMENT 2013-05-01
110527002983 2011-05-27 BIENNIAL STATEMENT 2011-05-01
090504002171 2009-05-04 BIENNIAL STATEMENT 2009-05-01

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Date of last update: 30 Mar 2025

Sources: New York Secretary of State