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LAKEWOOD PEDIATRIC DENTISTRY, PLLC

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Company Details

Name: LAKEWOOD PEDIATRIC DENTISTRY, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 18 Mar 2016 (9 years ago)
Entity Number: 4915433
ZIP code: 14710
County: Chautauqua
Place of Formation: New York
Address: 5101 BAKER STREET, ASHVILLE, NY, United States, 14710

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 5101 BAKER STREET, ASHVILLE, NY, United States, 14710

National Provider Identifier

NPI Number:
1417499500

Authorized Person:

Name:
DR. JAN CARLSON
Role:
OWNER/DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
1223P0221X - Pediatric Dentist
Is Primary:
Yes

Contacts:

Filings

Filing Number Date Filed Type Effective Date
200521000309 2020-05-21 CERTIFICATE OF PUBLICATION 2020-05-21
160318000543 2016-03-18 ARTICLES OF ORGANIZATION 2016-03-18

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Date of last update: 25 Mar 2025

Sources: New York Secretary of State