| Name: | BAYSIDE DENTAL INCORPORATED |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 28 Feb 1997 (28 years ago) |
| Date of Dissolution: | 29 Jul 2021 (4 years ago) |
| Date of Status Change: | 29 Jul 2021 (4 years ago) |
| Identification Number: | 000093843 |
| ZIP code: | 02809 |
| County: | Bristol County |
| Principal Address: | 15 GOODING AVENUE SUITE 1, BRISTOL, RI, 02809, USA |
| Purpose: | DENTAL PRACTICE. |
NAICS
621210 Offices of DentistsThis industry comprises establishments of health practitioners having the degree of D.M.D. (Doctor of Dental Medicine), D.D.S. (Doctor of Dental Surgery), or D.D.Sc. (Doctor of Dental Science) primarily engaged in the independent practice of general or specialized dentistry or dental surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. They can provide either comprehensive preventive, cosmetic, or emergency care, or specialize in a single field of dentistry. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942323621 | 2007-04-09 | 2020-08-22 | 15 GOODING AVE, SUITE 1, BRISTOL, RI, 028092600, US | 15 GOODING AVE, SUITE 1, BRISTOL, RI, 028092600, US | |||||||||||||||||||
|
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| Phone | +1 401-253-3781 |
| Fax | 4012539324 |
Authorized person
| Name | DR. PAUL M KOTUBY JR. |
| Role | DENTIST |
| Phone | 4012533781 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DEN01874 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PAUL M. KOTUBY JR. | Agent | 15 GOODING AVENUE SUITE 1, BRISTOL, RI, 02809, USA |
| Name | Role | Address |
|---|---|---|
| PAUL M KOTUBY D.M.D. JR. | PRESIDENT | PO BOX 178 BRISTOL, RI 02809- USA |
| Number | Name | File Date |
|---|---|---|
| 202100988620 | Registered Office Not Maintained | 2021-09-03 |
| 202199640540 | Revocation Certificate For Failure to File the Annual Report for the Year | 2021-07-29 |
| 202196780140 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202030986970 | Annual Report | 2020-01-02 |
| 202030985720 | Statement of Change of Registered/Resident Agent | 2020-01-02 |
| 201918936210 | Annual Report - Amended | 2019-09-11 |
| 201883404020 | Annual Report | 2018-12-30 |
| 201855711620 | Annual Report | 2018-01-05 |
| 201729636370 | Annual Report | 2017-01-06 |
| 201690533650 | Annual Report | 2016-01-14 |
Date of last update: 09 Apr 2025
Sources: Rhode Island Department of State
