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  5. PETITO ORAL SURGERY, LLC

PETITO ORAL SURGERY, LLC

Company Details

Name: PETITO ORAL SURGERY, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 28 Mar 2011 (14 years ago)
Identification Number: 000618627
ZIP code: 02914
County: Providence County
Principal Address: 400 MASSASOIT AVENUE SUITE 103, EAST PROVIDENCE, RI, 02914, USA
Purpose: DENTAL AND ORAL SURGERY SERVICES
NAICS: 621210 - Offices of Dentists

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1134414154 2011-06-17 2011-06-17 400 MASSASOIT AVE, SUITE 103, EAST PROVIDENCE, RI, 029142012, US 400 MASSASOIT AVE, SUITE 103, EAST PROVIDENCE, RI, 029142012, US

Contacts
Phone +1 401-578-1866
Fax 5083366580

Authorized person
Name DR. ANTHONY ROCCO PETITO
Role OWNER
Phone 4015781688

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number 2552
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2023 451273974 2024-05-14 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2024-05-14
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-05-14
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2022 451273974 2023-10-03 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2023-10-03
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-03
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2021 451273974 2022-04-05 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2022-04-05
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-05
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2020 451273974 2021-07-14 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2021-07-14
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-14
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2019 451273974 2020-05-20 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2020-05-20
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-20
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2018 451273974 2019-01-29 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2019-01-29
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-01-29
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2017 451273974 2018-01-30 PETITO ORAL SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2018-01-30
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-01-30
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2016 451273974 2017-02-28 PETITO ORAL SURGERY, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2017-02-28
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-02-28
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC 401(K) PROFIT SHARING PLAN 2015 451273974 2016-02-23 PETITO ORAL SURGERY, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2016-02-23
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-02-23
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
PETITO ORAL SURGERY, LLC DEFINED BENEFIT PENSION PLAN 2015 451273974 2016-11-10 PETITO ORAL SURGERY, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2016-11-10
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-11-10
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/02/23/20160223101610P040010328375001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2016-02-23
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-02-23
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/03/17/20150317094027P040136106439001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2015-03-17
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-03-17
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/03/17/20150317093408P040136103111001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2015-03-17
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-03-17
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/07/20141007075728P030001981177001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2014-10-07
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-07
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/02/18/20140218115650P040219055219001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2014-02-18
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-02-18
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/30/20130730125249P040328555619001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 339110
Sponsor’s telephone number 4015781866
Plan sponsor’s address 6749 POST ROAD, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2013-07-30
Name of individual signing PETITO ORAL SURGERY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/04/02/20130402110830P030017848583001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4019195560
Plan sponsor’s address 400 MASSASOIT AVENUE, SUITE #103, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2013-04-02
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-02
Name of individual signing ANTHONY PETITO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/24/20120724122727P040033215200001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 339110
Sponsor’s telephone number 4015781866
Plan sponsor’s address 6749 POST ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 451273974
Plan administrator’s name PETITO ORAL SURGERY
Plan administrator’s address 6749 POST ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4015781866

Signature of
Role Plan administrator
Date 2012-07-24
Name of individual signing PETITO ORAL SURGERY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ANTHONY PETITO Agent 400 MASSASOIT AVENUE SUITE 103, EAST PROVIDENCE, RI, 02914, USA

Filings

Number Name File Date
202447326150 Annual Report 2024-02-29
202338722540 Annual Report 2023-06-27
202337845420 Revocation Notice For Failure to File An Annual Report 2023-06-16
202208528340 Annual Report 2022-01-24
202101878100 Statement of Change of Registered/Resident Agent Office 2021-09-21
202100965630 Annual Report 2021-09-06
202059452010 Annual Report 2020-09-30
201919815550 Annual Report 2019-09-16
201877298240 Annual Report 2018-09-12
201749803280 Annual Report 2017-09-17

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Date of last update: 15 Oct 2024

Sources: Rhode Island Department of State

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