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Anthony J. Tilelli, D.D.S., Inc.

Company Details

Name: Anthony J. Tilelli, D.D.S., Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 17 Oct 2000 (24 years ago)
Identification Number: 000114908
ZIP code: 02893
County: Kent County
Principal Address: 336 COWESETT AVENUE, WEST WARWICK, RI, 02893, USA
Purpose: TO ENGAGE IN THE GENERAL PRACTICE OF DENTISTRY
NAICS: 621210 - Offices of Dentists

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1346674066 2013-08-29 2013-08-29 336 COWESETT AVE, WEST WARWICK, RI, 028932222, US 336 COWESETT AVE, WEST WARWICK, RI, 028932222, US

Contacts

Phone +1 401-828-2400
Fax 4018280051

Authorized person

Name DR. ANTHONY J TILELLI
Role OWNER
Phone 4018282400

Taxonomy

Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 1731
State RI
Is Primary Yes
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 3116
State RI
Is Primary No

Other Provider Identifiers

Issuer MEDICAID
Number AT02637
State RI
Issuer BLUE CROSS DENTAL
Number 8435-4
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANTHONY J. TILELLI, D.D.S. PROFIT SHARING PLAN 2018 050514295 2019-10-23 ANTHONY J. TILELLI, D.D.S., INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2019-10-23
Name of individual signing ANTHONY J TILELLI DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-23
Name of individual signing ANTHONY J TILELLI DDS
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S. PROFIT SHARING PLAN 2018 050514295 2019-03-20 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2019-03-20
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-03-20
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S. PROFIT SHARING PLAN 2017 050514295 2018-05-25 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2018-05-25
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-25
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S. PROFIT SHARING PLAN 2016 050514295 2017-07-18 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2017-07-18
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-18
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S.PROFIT SHARING PLAN 2015 050514295 2016-09-06 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2016-09-06
Name of individual signing ANTHONY J. TILELLI DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-06
Name of individual signing ANTHONY J. TILELLI DDS
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S.PROFIT SHARING PLAN 2014 050514295 2015-09-14 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2015-09-14
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-14
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S.PROFIT SHARING PLAN 2013 050514295 2014-09-18 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2014-09-18
Name of individual signing ANTHONY TILELLI DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-18
Name of individual signing ANTHONY TILELLI DDS
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S.PROFIT SHARING PLAN 2012 050514295 2013-09-28 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Signature of

Role Plan administrator
Date 2013-09-28
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-28
Name of individual signing ANTHONY J. TILELLI D.D.S.
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S.PROFIT SHARING PLAN 2011 050514295 2012-10-09 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Plan administrator’s name and address

Administrator’s EIN 050514295
Plan administrator’s name ANTHONY J. TILELLI, D.D.S., INC.
Plan administrator’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893
Administrator’s telephone number 4018282400

Signature of

Role Plan administrator
Date 2012-10-09
Name of individual signing ANTHONY TILELLI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-09
Name of individual signing ANTHONY TILELLI
Valid signature Filed with authorized/valid electronic signature
ANTHONY J. TILELLI, D.D.S.PROFIT SHARING PLAN 2010 050514295 2011-09-29 ANTHONY J. TILELLI, D.D.S., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Plan administrator’s name and address

Administrator’s EIN 050514295
Plan administrator’s name ANTHONY J. TILELLI, D.D.S., INC.
Plan administrator’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893
Administrator’s telephone number 4018282400

Signature of

Role Plan administrator
Date 2011-09-29
Name of individual signing ANTHONY J. TILELLI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-29
Name of individual signing ANTHONY J. TILELLI
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/08/20100908100619P030166131538001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621210
Sponsor’s telephone number 4018282400
Plan sponsor’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893

Plan administrator’s name and address

Administrator’s EIN 050514295
Plan administrator’s name ANTHONY J. TILELLI, D.D.S., INC.
Plan administrator’s address 336 COWESETT AVENUE, WEST WARWICK, RI, 02893
Administrator’s telephone number 4018282400

Signature of

Role Plan administrator
Date 2010-09-08
Name of individual signing ANTHONY J. TILELLI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-08
Name of individual signing ANTHONY J. TILELLI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GREGORY A. PORCARO Agent 2258 POST ROAD, WARWICK, RI, 02886, USA

PRESIDENT

Name Role Address
ANTHONY J TILELLI DDS PRESIDENT 73 SAXONY DRIVE WARWICK, RI 02886- USA

Filings

Number Name File Date
202454820720 Annual Report 2024-05-23
202336085070 Annual Report 2023-05-25
202210982570 Annual Report 2022-02-16
202193208700 Annual Report 2021-02-27
202035420190 Annual Report 2020-02-28
201986798620 Annual Report 2019-02-16
201859228980 Annual Report 2018-02-26
201733714260 Annual Report 2017-02-06
201690828990 Annual Report 2016-01-15
201553954770 Annual Report 2015-01-20

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State