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NORTH SHORE ORAL SURGERY, LLC

NORTH SHORE ORAL SURGERY, LLC

Company Details

Name:	NORTH SHORE ORAL SURGERY, LLC
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status:	Active
Date of registration:	16 Feb 2011 (14 years ago)
Entity Number:	4055931
ZIP code:	11787
County:	Suffolk
Place of Formation:	New York
Address:	222 MIDDLE COUNTRY RD, STE 101, SMITHTOWN, NY, United States, 11787

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

NORTH SHORE ORAL SURGERY, LLC PROFIT SHARING PLAN

2018

450975075

2020-09-08

NORTH SHORE ORAL SURGERY, LLC

2

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	6318041893
Plan sponsor’s address	222 MIDDLE COUNTRY ROAD, SUITE #101, SMITHTOWN, NY, 11787

Signature of

Role	Plan administrator
Date	2020-09-08
Name of individual signing	ALEX MONTAZEM

NORTH SHORE ORAL SURGERY, LLC PROFIT SHARING PLAN

2017

450975075

2018-07-30

NORTH SHORE ORAL SURGERY, LLC

2

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	6318041893
Plan sponsor’s address	222 MIDDLE COUNTRY ROAD, SUITE #101, SMITHTOWN, NY, 11787

Signature of

Role	Plan administrator
Date	2018-07-30
Name of individual signing	ALEX MONTAZEM

NORTH SHORE ORAL SURGERY, LLC PROFIT SHARING PLAN

2016

450975075

2017-07-30

NORTH SHORE ORAL SURGERY, LLC

2

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	6318041893
Plan sponsor’s address	222 MIDDLE COUNTRY ROAD, SUITE #101, SMITHTOWN, NY, 11787

Signature of

Role	Plan administrator
Date	2017-07-30
Name of individual signing	ALEX MONTAZEM

NORTH SHORE ORAL SURGERY, LLC PROFIT SHARING PLAN

2015

450975075

2016-07-29

NORTH SHORE ORAL SURGERY, LLC

2

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	6318041893
Plan sponsor’s address	222 MIDDLE COUNTRY ROAD, SUITE #101, SMITHTOWN, NY, 11787

Signature of

Role	Plan administrator
Date	2016-07-29
Name of individual signing	ALEX MONTAZEM

NORTH SHORE ORAL SURGERY, LLC PROFIT SHARING PLAN

2014

450975075

2015-11-18

NORTH SHORE ORAL SURGERY, LLC

2

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	6318041893
Plan sponsor’s address	222 MIDDLE COUNTRY ROAD, SUITE #101, SMITHTOWN, NY, 11787

Signature of

Role	Plan administrator
Date	2015-11-18
Name of individual signing	ALEX MONTAZEM

Role	Employer/plan sponsor
Date	2015-11-18
Name of individual signing	ALEX MONTAZEM

DOS Process Agent

Name	Role	Address
THE LLC	DOS Process Agent	222 MIDDLE COUNTRY RD, STE 101, SMITHTOWN, NY, United States, 11787

History

Start date	End date	Type	Value
2011-02-16	2013-02-28	Address	ONE SHEN COURT, SETAUKET, NY, 11733, USA (Type of address: Service of Process)

Filings

Filing Number	Date Filed	Type	Effective Date
130228002229	2013-02-28	BIENNIAL STATEMENT	2013-02-01
110711000207	2011-07-11	CERTIFICATE OF PUBLICATION	2011-07-11
110216000370	2011-02-16	ARTICLES OF ORGANIZATION	2011-02-16

Date of last update: 16 Jan 2025

Sources: New York Secretary of State