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  5. Lakeshore Family Dentistry, P.A.

Lakeshore Family Dentistry, P.A.

Company Details

Name: Lakeshore Family Dentistry, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 17 Nov 1969 (55 years ago)
Company Number: 9861b7c4-a6d4-e011-a886-001ec94ffe7f
File Number: 1T-880
Registered Office Address: 4706 Banning Ave, White Bear Lake, MN 55110–3216, USA
ZIP code: 55110
County: Ramsey County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2023 410957889 2024-05-22 LAKESHORE FAMILY DENTISTRY, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2024-05-22
Name of individual signing JASON ROSS
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2022 410957889 2023-10-02 LAKESHORE FAMILY DENTISTRY, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing JASON ROSS
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2021 410957889 2022-09-20 LAKESHORE FAMILY DENTISTRY, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2022-09-20
Name of individual signing JASON ROSS
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2020 410957889 2021-09-28 LAKESHORE FAMILY DENTISTRY, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2021-09-28
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2019 410957889 2020-10-08 LAKESHORE FAMILY DENTISTRY, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2018 410957889 2019-09-03 LAKESHORE FAMILY DENTISTRY, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2019-09-03
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2017 410957889 2018-10-11 LAKESHORE FAMILY DENTISTRY, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2018-10-11
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2016 410957889 2017-08-03 LAKESHORE FAMILY DENTISTRY, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2017-08-03
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2015 410957889 2016-08-19 LAKESHORE FAMILY DENTISTRY, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2016-08-19
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature
LAKESHORE FAMILY DENTISTRY, P.A. 401(K) PROFIT SHARING PLAN 2014 410957889 2015-08-06 LAKESHORE FAMILY DENTISTRY, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6514290424
Plan sponsor’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110

Plan administrator’s name and address
Administrator’s EIN 410957889
Plan administrator’s name LAKESHORE FAMILY DENTISTRY, P.A.
Plan administrator’s address 4706 BANNING AVE., WHITE BEAR LAKE, MN, 55110
Administrator’s telephone number 6514290424

Signature of
Role Plan administrator
Date 2015-08-06
Name of individual signing SCOTT KRON
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Jason Ross Chief Executive Officer 4706 Banning Ave, White Bear Lake, MN 55110–3216, USA

Filing

Filing Name Filing date
Business Corporation (Domestic) Business Name (Business Name: Lakeshore Family Dentistry, P.A.) 1997-04-14
Registered Office and/or Agent - Business Corporation (Domestic) 1988-10-21
Business Corporation (Domestic) Active Status Report 1981-01-30
Business Corporation (Domestic) Business Name (Business Name: Kenyon, Wright & Kron, D.D.S., P.A.) 1979-11-21
Business Corporation (Domestic) Business Name (Business Name: Kenyon, Wright, Fletcher & Kron, D.D.S., P.A.) 1979-01-17
Business Corporation (Domestic) Business Name (Business Name: Kenyon, Wright & Fletcher, P.A.) 1976-05-28
Original Filing - Business Corporation (Domestic) 1969-11-17
Business Corporation (Domestic) Business Name (Business Name: Kenyon, Wright & Hurd, P.A.) 1969-11-17

Related by officers

Jason Ross

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Related by address

4706 Banning Ave, White Bear Lake, MN 55110–3216, USA

Banning Avenue Professional Building, LLP Banning Avenue Professional Building, LLP Banning Avenue Professional Building, LLP BANNING AVENUE PROFESSIONAL BUILDING, LLP

Date of last update: 14 Dec 2024

Sources: Minnesota's Official State Website

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