| Name: | 31 Elmgrove Dental LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 20 Mar 2018 (7 years ago) |
| Identification Number: | 001682647 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 194 CHACE AVE, PROVIDENCE, RI, 02906, USA |
| Purpose: | DENTISTRY |
| Fictitious names: |
Page Family Dentistry (trading name, 2021-11-23 - ) |
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 | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225787708 | 2022-03-22 | 2022-03-22 | 31 ELMGROVE AVE, PROVIDENCE, RI, 029064103, US | 31 ELMGROVE AVE, PROVIDENCE, RI, 029064103, US | |||||||||||||||||||||
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| Phone | +1 401-421-9350 |
| Fax | 4014216450 |
Authorized person
| Name | MRS. JESSICA A POLAK |
| Role | OFFICE MANAGER |
| Phone | 4014219350 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | MP01974 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 31 ELMGROVE DENTAL LLC 401(K) PLAN | 2023 | 824866705 | 2024-03-13 | 31 ELMGROVE DENTAL LLC | 9 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-03-13 |
| Name of individual signing | MARC PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-03-13 |
| Name of individual signing | MARC PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1973-11-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 4012721474 |
| Plan sponsor’s address | 31 ELMGROVE AVENUE, PROVIDENCE, RI, 02906 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-15 |
| Name of individual signing | MARC PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2023-05-15 |
| Name of individual signing | MARC PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1973-11-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 4012721474 |
| Plan sponsor’s address | 31 ELMGROVE AVENUE, PROVIDENCE, RI, 02906 |
Signature of
| Role | Plan administrator |
| Date | 2022-02-25 |
| Name of individual signing | MARC PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-02-25 |
| Name of individual signing | MARC PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MARC J PAGE | Agent | 194 CHACE AVE, PROVIDENCE, RI, 02906, USA |
| Number | Name | File Date |
|---|---|---|
| 202452133110 | Annual Report | 2024-04-23 |
| 202328377130 | Annual Report | 2023-02-14 |
| 202221244430 | Annual Report | 2022-07-14 |
| 202219277000 | Revocation Notice For Failure to File An Annual Report | 2022-06-22 |
| 202105308540 | Fictitious Business Name Statement | 2021-11-23 |
| 202100670660 | Annual Report | 2021-09-01 |
| 202057489450 | Annual Report | 2020-09-23 |
| 201925031960 | Annual Report | 2019-11-14 |
| 201860662050 | Articles of Organization | 2018-03-20 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
