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31 Elmgrove Dental LLC

Company Details

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
NAICS: 621210 - Offices of Dentists
Fictitious names: Page Family Dentistry (trading name, 2021-11-23 - )

National Provider Identifier

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

Contacts

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

form 5500

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
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 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
31 ELMGROVE DENTAL LLC 401(K) PLAN 2022 824866705 2023-05-15 31 ELMGROVE DENTAL LLC 9
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
31 ELMGROVE DENTAL LLC 401(K) PLAN 2021 824866705 2022-02-25 31 ELMGROVE DENTAL LLC 8
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

Agent

Name Role Address
MARC J PAGE Agent 194 CHACE AVE, PROVIDENCE, RI, 02906, USA

Filings

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