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ELMWOOD VILLAGE DENTAL, P.C.

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Company Details

Name: ELMWOOD VILLAGE DENTAL, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 18 Nov 2021 (4 years ago)
Entity Number: 6331037
ZIP code: 14222
County: Erie
Place of Formation: New York
Address: 892 Elmwood Avenue, Buffalo, NY, United States, 14222

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
ROBERT J. LACARRUBBA Chief Executive Officer 892 ELMWOOD AVENUE, BUFFALO, NY, United States, 14222

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 892 Elmwood Avenue, Buffalo, NY, United States, 14222

Unique Entity ID

Unique Entity ID:
TLAWCKFU5N99
UEI Expiration Date:
2026-06-04

Business Information

Activation Date:
2025-06-06
Initial Registration Date:
2022-11-16

National Provider Identifier

NPI Number:
1659032639
Certification Date:
2022-01-03

Authorized Person:

Name:
DEBORAH DAMICO
Role:
CREDENTIALING LIAISON
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
7165577225
Fax:
7168810449

History

Start date End date Type Value
2021-11-18 2025-02-10 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2021-11-18 2025-02-10 Address 4927 MAIN STREET, AMHERST, NY, 14226, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
250210003740 2025-02-10 BIENNIAL STATEMENT 2025-02-10
211118001797 2021-11-18 CERTIFICATE OF INCORPORATION 2021-11-18

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Date of last update: 21 Mar 2025

Sources: New York Secretary of State