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  5. Maxillofacial Surgeons, Ltd.

Maxillofacial Surgeons, Ltd.

Company Details

Name: Maxillofacial Surgeons, Ltd.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 26 Dec 1991 (33 years ago)
Date of Dissolution: 28 Mar 2014 (11 years ago)
Date of Status Change: 28 Mar 2014 (11 years ago)
Identification Number: 000066321
ZIP code: 02888
County: Kent County
Principal Address: 243 JEFFERSON BOULEVARD, WARWICK, RI, 02888, USA
Purpose: ENGAGING IN THE RENDERING OF SERVICES OF ORAL AND MAXILLOFACIAL SURGEONS.
Fictitious names: MSL Facial & Oral Surgery (trading name, 2004-06-09 - )
Historical names: MSI Supply, Inc.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1972579183 2006-02-27 2020-08-22 243 JEFFERSON BLVD, WARWICK, RI, 028883818, US 243 JEFFERSON BLVD, WARWICK, RI, 028883818, US

Contacts
Phone +1 401-739-5500
Fax 4017381550

Authorized person
Name DR. ANTHONY R PETITO
Role PRESIDENT
Phone 4017395500

Taxonomy
Taxonomy Code 204E00000X - Oral & Maxillofacial Surgery (D.M.D.)
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 9008578
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MSL DEFINED BENEFIT PENSION PLAN 2019 050462827 2020-10-12 MAXILLOFACIAL SURGEONS, LTD. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Plan sponsor’s address 243 JEFFERSON BLVD, WARWICK, RI, 028883818

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing FRANK PALETTA
Valid signature Filed with authorized/valid electronic signature
MSL 401(K) PROFIT SHARING PLAN 2019 050462827 2020-07-07 MAXILLOFACIAL SURGEONS, LTD. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4017373637
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 028883818
MSL DEFINED BENEFIT PENSION PLAN 2018 050462827 2019-06-28 MAXILLOFACIAL SURGEONS, LTD 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD, WARWICK, RI, 02888
MSL 401(K) PROFIT SHARING PLAN 2018 050462827 2019-08-08 MAXILLOFACIAL SURGEONS, LTD. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4017373637
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 028883818
MSL DEFINED BENEFIT PENSION PLAN 2017 050462827 2018-10-10 MAXILLOFACIAL SURGEONS, LTD 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD, WARWICK, RI, 02888
MSL 401(K) PROFIT SHARING PLAN 2017 050462827 2018-02-13 MAXILLOFACIAL SURGEONS, LTD. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4017373637
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 028883818
MSL DEFINED BENEFIT PENSION PLAN 2016 050462827 2017-07-05 MAXILLOFACIAL SURGEONS, LTD 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD, WARWICK, RI, 02888
MSL 401(K) PROFIT SHARING PLAN 2016 050462827 2017-06-30 MAXILLOFACIAL SURGEONS, LTD. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4017373637
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 028883818
MSL DEFINED BENEFIT PENSION PLAN 2015 050462827 2016-05-11 MAXILLOFACIAL SURGEONS, LTD. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888

Signature of
Role Plan administrator
Date 2016-05-11
Name of individual signing FRANK PALETTA
Valid signature Filed with authorized/valid electronic signature
MSL DEFINED BENEFIT PENSION PLAN 2014 050462827 2015-04-23 MAXILLOFACIAL SURGEONS, LTD. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888

Signature of
Role Plan administrator
Date 2015-04-23
Name of individual signing FRANK PALETTA
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/23/20140923085231P040015605905001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888

Signature of
Role Plan administrator
Date 2014-09-23
Name of individual signing FRANK PALETTA
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/23/20130923103620P030000904549001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888

Plan administrator’s name and address
Administrator’s EIN 050462827
Plan administrator’s name MAXILLOFACIAL SURGEONS, LTD.
Plan administrator’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888
Administrator’s telephone number 4017395500

Signature of
Role Plan administrator
Date 2013-09-23
Name of individual signing FRANK PALETTA
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/09/20121009130347P040000869270001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 4017395500
Plan sponsor’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888

Plan administrator’s name and address
Administrator’s EIN 050462827
Plan administrator’s name MAXILLOFACIAL SURGEONS, LTD.
Plan administrator’s address 243 JEFFERSON BLVD., WARWICK, RI, 02888
Administrator’s telephone number 4017395500

Signature of
Role Plan administrator
Date 2012-10-09
Name of individual signing FRANK PALETTA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JENNY C. WILLIFORD, ESQ. Agent TATE LATHAM & DURANT LLC 321 SOUTH MAIN STREET, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
ATNHONY PETITO DDS PRESIDENT 30 BOW STREET EAST GREENWICH, RI 02818- USA

Events

Type Date Old Value New Value
Name Change 1992-01-03 MSI Supply, Inc. Maxillofacial Surgeons, Ltd.

Filings

Number Name File Date
201437932960 Articles of Dissolution 2014-03-28
201297829930 Revocation Certificate For Failure to File the Annual Report for the Year 2012-09-14
201293007080 Revocation Notice For Failure to File An Annual Report 2012-05-23
201184959850 Statement of Change of Registered/Resident Agent 2011-11-09
201174825310 Annual Report 2011-02-11
201056478520 Annual Report 2010-01-19
200951964400 Statement of Change of Registered/Resident Agent Office 2009-10-02
200941172150 Annual Report 2009-01-27
200806017800 Annual Report 2008-01-18

Related by officers

JENNY C. WILLIFORD, ESQ.

BANEDAW LLC

Related by address

243 JEFFERSON BOULEVARD, WARWICK, RI, 02888, USA

BANEDAW LLC CLATIHAC, LLC FACIAL & ORAL SURGERY, LLC ARTISTIC CONTOURS, LLC Better Body, LLC

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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