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  5. DUTCHMAN DENTAL, LLC

DUTCHMAN DENTAL, LLC

Company Details

Name: DUTCHMAN DENTAL, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 25 Feb 2005 (20 years ago)
Identification Number: 000146197
ZIP code: 02878
County: Newport County
Principal Address: 1359 MAIN ROAD, TIVERTON, RI, 02878, USA
Mailing Address: 25 HIGHLAND ROAD, TIVERTON, RI, 02878, USA
Purpose: REAL ESTATE HOLDING
NAICS: 531110 - Lessors of Residential Buildings and Dwellings
Historical names: DUTCHMEN DENTAL, LLC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912172016 2008-04-29 2008-04-29 1359 MAIN RD, TIVERTON, RI, 028784426, US 1359 MAIN RD, TIVERTON, RI, 028784426, US

Contacts
Phone +1 401-624-9177
Fax 4016249233

Authorized person
Name MR. JON PAUL VAN REGENMORTER
Role OWNER
Phone 4016249177

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number DEN02748
State RI
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD OF RI
Number 8094-5
State RI
Issuer BLUE CROSS BLUE SHIELD OF MA
Number X12325
State MA
Issuer MEDICAID
Number 0281077
State MA
Issuer MEDICAID
Number 9197544
State MA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DUTCHMAN DENTAL, LLC 401(K) PLAN 2022 161746847 2023-10-02 DUTCHMAN DENTAL, LLC 75
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing JAMES TOWERS
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2021 161746847 2022-11-21 DUTCHMAN DENTAL, LLC 58
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Signature of
Role Plan administrator
Date 2022-11-21
Name of individual signing JAMES TOWERS
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2020 161746847 2021-09-22 DUTCHMAN DENTAL, LLC 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Signature of
Role Plan administrator
Date 2021-09-22
Name of individual signing JAMES TOWERS
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2019 161746847 2020-10-15 DUTCHMAN DENTAL, LLC 47
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing JAMES TOWERS
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2019 161746847 2020-11-20 DUTCHMAN DENTAL, LLC 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Signature of
Role Plan administrator
Date 2020-11-20
Name of individual signing JAMES TOWERS
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2018 161746847 2019-08-02 DUTCHMAN DENTAL, LLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2019-08-02
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2017 161746847 2018-08-24 DUTCHMAN DENTAL, LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2018-08-24
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2016 161746847 2017-08-08 DUTCHMAN DENTAL, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2017-08-08
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2015 161746847 2016-06-20 DUTCHMAN DENTAL, LLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2016-06-20
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
DUTCHMAN DENTAL, LLC 401(K) PLAN 2014 161746847 2015-08-21 DUTCHMAN DENTAL, LLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2015-08-21
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/08/04/20140804154029P040003612457001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2014-08-04
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/23/20130923123034P030003555635001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2013-09-23
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/31/20120731115009P040019852130001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2012-07-31
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/27/20110727093712P040032699063001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-27
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-27
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/31/20100831145017P030469800433001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 4016249177
Plan sponsor’s address 1359 MAIN ROAD, TIVERTON, RI, 02878

Plan administrator’s name and address
Administrator’s EIN 161746847
Plan administrator’s name DUTCHMAN DENTAL, LLC
Plan administrator’s address 1359 MAIN ROAD, TIVERTON, RI, 02878
Administrator’s telephone number 4016249177

Signature of
Role Plan administrator
Date 2010-08-31
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-31
Name of individual signing JON PAUL VAN REGENMORTER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JEROME V. SWEENEY, III Agent 41 MENDON AVENUE, PAWTUCKET, RI, 02861, USA

Manager

Name Role Address
JON PAUL VANREGENMORTER Manager 25 HIGHLAND ROAD TIVERTON, RI 02878 USA

Events

Type Date Old Value New Value
Name Change 2013-12-17 DUTCHMEN DENTAL, LLC DUTCHMAN DENTAL, LLC

Filings

Number Name File Date
202449426010 Annual Report 2024-03-25
202329983880 Annual Report 2023-03-03
202214221710 Annual Report 2022-04-01
202207960240 Annual Report 2022-01-13
202106504770 Revocation Notice For Failure to File An Annual Report 2021-12-03
202064879080 Annual Report 2020-10-08
201918737240 Annual Report 2019-09-06
201877222830 Annual Report 2018-09-12
201749547580 Annual Report 2017-09-11
201608623710 Annual Report 2016-09-09

Related by officers

JEROME V. SWEENEY, III

Providence Rental Systems, Inc. Utica Rental Systems, Inc. Project Change CICMA-LLANO PRODUCTIONS, INC. 58 Curtis Street, LLC REVENUE TECHNOLOGY SYSTEMS, INC. Highland Investment Group, Inc. 146 Westminster Street, LLC PTH QTIP REALTY 146 WESTMINSTER, LLC 234 Irving Avenue, LLC

JON PAUL VANREGENMORTER

Highland Investment Group, Inc.

Related by address

1359 MAIN ROAD, TIVERTON, RI, 02878, USA

DMV HOLDING COMPANY, LLC Highland Investment Group, Inc.

25 HIGHLAND ROAD, TIVERTON, RI, 02878, USA

DMV HOLDING COMPANY, LLC

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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