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  5. Woonsocket Dental Associates, Inc.

Woonsocket Dental Associates, Inc.

Company Details

Name: Woonsocket Dental Associates, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 30 Mar 1992 (33 years ago)
Identification Number: 000067496
ZIP code: 02895
County: Providence County
Principal Address: 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895, USA
Purpose: DENTAL
NAICS: 621210 - Offices of Dentists

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1861585671 2006-10-02 2020-08-22 2000 DIAMOND HILL RD, WOONSOCKET, RI, 028951554, US 2000 DIAMOND HILL RD, WOONSOCKET, RI, 028951554, US

Contacts
Phone +1 401-766-8600
Fax 4017668601

Authorized person
Name DR. MICHAEL BRIAN FORMAN
Role PRESIDENT
Phone 4017668600

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number DN2031
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number WD02303
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2023 050464777 2024-06-04 WOONSOCKET DENTAL ASSOCIATES, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2024-06-04
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2022 050464777 2023-08-13 WOONSOCKET DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2023-08-13
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2021 050464777 2022-07-28 WOONSOCKET DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2020 050464777 2021-06-24 WOONSOCKET DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2021-06-24
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2019 050464777 2020-06-04 WOONSOCKET DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2020-06-04
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2018 050464777 2019-05-09 WOONSOCKET DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2019-05-09
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2017 050464777 2018-06-28 WOONSOCKET DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2018-06-28
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2016 050464777 2017-05-31 WOONSOCKET DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2017-05-31
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2015 050464777 2016-06-09 WOONSOCKET DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2016-06-09
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
WOONSOCKET DENTAL ASSOCIATES, INC, 401(K) PROFIT SHARING PLAN 2014 050464777 2015-07-18 WOONSOCKET DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2015-07-18
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/02/20140702153000P040020541431001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2014-07-02
Name of individual signing MICHAEL FORMAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/10/20131010090035P030028824355001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Signature of
Role Plan administrator
Date 2013-10-10
Name of individual signing THOMAS FECTEAU
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/10/20121010123302P040001077670001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Plan administrator’s name and address
Administrator’s EIN 050464777
Plan administrator’s name WOONSOCKET DENTAL ASSOCIATES, INC.
Plan administrator’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895
Administrator’s telephone number 4017668600

Signature of
Role Plan administrator
Date 2012-10-10
Name of individual signing THOMAS FECTEAU
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/13/20110613112056P040011344354001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Plan administrator’s name and address
Administrator’s EIN 050464777
Plan administrator’s name WOONSOCKET DENTAL ASSOCIATES, INC.
Plan administrator’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895
Administrator’s telephone number 4017668600

Signature of
Role Plan administrator
Date 2011-06-13
Name of individual signing THOMAS FECTEAU
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/28/20100728090825P070025401106001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 4017668600
Plan sponsor’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895

Plan administrator’s name and address
Administrator’s EIN 050464777
Plan administrator’s name WOONSOCKET DENTAL ASSOCIATES, INC.
Plan administrator’s address 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895
Administrator’s telephone number 4017668600

Signature of
Role Plan administrator
Date 2010-07-28
Name of individual signing THOMAS FECTEAU
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MICHAEL B. FORMAN Agent 2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895, USA

PRESIDENT

Name Role Address
MICHAEL B FORMAN PRESIDENT 48 LONESOME PINE ROAD CUMBERLAND, RI 02864- USA

Filings

Number Name File Date
202449862250 Annual Report 2024-03-31
202326369380 Annual Report 2023-01-21
202209579350 Annual Report 2022-02-07
202185456210 Annual Report 2021-01-09
202031814290 Annual Report 2020-01-10
201984258360 Annual Report 2019-01-11
201856121220 Annual Report 2018-01-14
201729644320 Annual Report 2017-01-07
201691924330 Annual Report 2016-02-04
201553852670 Annual Report 2015-01-18

Related by officers

MICHAEL B. FORMAN

WOONSOCKET FAMILY DENTAL CENTER, INC.

Related by address

2000 DIAMOND HILL ROAD, WOONSOCKET, RI, 02895, USA

MAY FLOWER, INC. New China Super Buffet Inc. The GSP Foundation

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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