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  5. Shaghalian Family Dental, LLC

Shaghalian Family Dental, LLC

Company Details

Name: Shaghalian Family Dental, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Dissolved
Date of Organization in Rhode Island: 16 Mar 2016 (9 years ago)
Date of Dissolution: 14 Dec 2022 (2 years ago)
Date of Status Change: 14 Dec 2022 (2 years ago)
Identification Number: 001661411
ZIP code: 02916
County: Providence County
Principal Address: 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916, USA
Purpose: DENTAL PRACTICE
NAICS: 621210 - Offices of Dentists

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1568904571 2016-11-08 2016-11-08 1002 PAWTUCKET AVE, RUMFORD, RI, 029161704, US 1002 PAWTUCKET AVE, RUMFORD, RI, 029161704, US

Contacts
Phone +1 401-438-4964
Fax 4014346021

Authorized person
Name DR. JUSTIN W SHAGHALIAN
Role DENTIST/OWNER
Phone 4014384964

Taxonomy
Taxonomy Code 122300000X - Dentist
License Number DEN02886
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SHAGHALIAN FAMILY DENTAL, LLC 401(K) PLAN 2021 811868515 2022-03-04 SHAGHALIAN FAMILY DENTAL, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 4014384964
Plan sponsor’s address 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916

Signature of
Role Plan administrator
Date 2022-03-04
Name of individual signing DAVID SYNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-04
Name of individual signing DAVID SYNER
Valid signature Filed with authorized/valid electronic signature
SHAGHALIAN FAMILY DENTAL, LLC 401(K) PLAN 2021 811868515 2022-04-25 SHAGHALIAN FAMILY DENTAL, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 4014384964
Plan sponsor’s address 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916

Signature of
Role Plan administrator
Date 2022-04-25
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-25
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
SHAGHALIAN FAMILY DENTAL, LLC 401(K) PLAN 2020 811868515 2021-04-21 SHAGHALIAN FAMILY DENTAL, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 4014384964
Plan sponsor’s address 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916

Signature of
Role Plan administrator
Date 2021-04-18
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-18
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
SHAGHALIAN FAMILY DENTAL, LLC 401(K) PLAN 2019 811868515 2020-02-28 SHAGHALIAN FAMILY DENTAL, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 4014384964
Plan sponsor’s address 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916

Signature of
Role Plan administrator
Date 2020-02-28
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-02-28
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
SHAGHALIAN FAMILY DENTAL, LLC 401(K) PLAN 2018 811868515 2019-02-27 SHAGHALIAN FAMILY DENTAL, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 4014384964
Plan sponsor’s address 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916

Signature of
Role Plan administrator
Date 2019-02-27
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-02-27
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
SHAGHALIAN FAMILY DENTAL, LLC 401(K) PLAN 2017 811868515 2018-03-28 SHAGHALIAN FAMILY DENTAL, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 4014384964
Plan sponsor’s address 1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916

Signature of
Role Plan administrator
Date 2018-03-28
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-03-28
Name of individual signing JUSTIN SHAGHALIAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ORSON AND BRUSINI LTD. Agent 211 QUAKER LANE SUITE 201, WEST WARWICK, RI, 02893, USA

MANAGER

Name Role Address
JUSTIN W. SHAGHALIAN, DMD MANAGER 1002 PAWTUCKET AVENUE RUMFORD, RI 02916 USA

Filings

Number Name File Date
202225178650 Articles of Dissolution 2022-12-14
202224399380 Statement of Change of Registered/Resident Agent Office 2022-10-21
202212287330 Annual Report 2022-03-02
202102265990 Annual Report 2021-09-28
202064877310 Annual Report 2020-10-08
201921951370 Annual Report 2019-09-30
201878208040 Annual Report 2018-09-24
201751458700 Annual Report 2017-10-12
201694749200 Articles of Organization 2016-03-16

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ORSON AND BRUSINI LTD.

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Related by address

1002 PAWTUCKET AVENUE, RUMFORD, RI, 02916, USA

1002 Pawtucket Avenue, LLC

Date of last update: 26 Oct 2024

Sources: Rhode Island Department of State

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