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  5. DIAZ DENTAL CLINIC, P.A.

DIAZ DENTAL CLINIC, P.A.

Company Details

Name: DIAZ DENTAL CLINIC, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 05 Oct 1987 (37 years ago)
Business ID: 8704779
ZIP code: 39750
County: Webster
State of Incorporation: MISSISSIPPI
Principal Office Address: 811 2nd Avenue, P O Box 653Maben, MS 39750

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2018 640749808 2019-04-09 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2019-04-09
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2017 640749808 2018-06-01 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2018-06-01
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2016 640749808 2017-04-17 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2017-04-17
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2015 640749808 2016-05-23 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2016-05-23
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2014 640749808 2015-04-13 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2015-04-13
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2013 640749808 2014-04-21 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2014-04-21
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2012 640749808 2013-03-25 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Signature of
Role Plan administrator
Date 2013-03-25
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2011 640749808 2012-04-29 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Plan administrator’s name and address
Administrator’s EIN 640749808
Plan administrator’s name DIAZ DENTAL CLINIC, P.A.
Plan administrator’s address P.O. BOX 653, MABEN, MS, 397500653
Administrator’s telephone number 6622638444

Signature of
Role Plan administrator
Date 2012-04-29
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2010 640749808 2011-04-26 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Plan administrator’s name and address
Administrator’s EIN 640749808
Plan administrator’s name DIAZ DENTAL CLINIC, P.A.
Plan administrator’s address P.O. BOX 653, MABEN, MS, 397500653
Administrator’s telephone number 6622638444

Signature of
Role Plan administrator
Date 2011-04-26
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature
DIAZ DENTAL CLINIC, P.A. PROFIT SHARING PLAN 2009 640749808 2010-07-14 DIAZ DENTAL CLINIC, P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 6622638444
Plan sponsor’s address P.O. BOX 653, MABEN, MS, 397500653

Plan administrator’s name and address
Administrator’s EIN 640749808
Plan administrator’s name DIAZ DENTAL CLINIC, P.A.
Plan administrator’s address P.O. BOX 653, MABEN, MS, 397500653
Administrator’s telephone number 6622638444

Signature of
Role Plan administrator
Date 2010-07-14
Name of individual signing WALTER DIAZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WALTER D DIAZ Agent 2ND AVENUE, P O BOX 653, MABEN, MS 39750

Director

Name Role Address
Walter D Diaz Director 811 2nd AvenueP O Box 653, Maben, MS 39750
Janie Diaz Director 811 2nd Avenue Po Box 653, Maben, MS 39750

President

Name Role Address
Walter D Diaz President 811 2nd AvenueP O Box 653, Maben, MS 39750

Secretary

Name Role Address
Janie Diaz Secretary 811 2nd Avenue Po Box 653, Maben, MS 39750

Treasurer

Name Role Address
Janie Diaz Treasurer 811 2nd Avenue Po Box 653, Maben, MS 39750

Assistant Secretary

Name Role Address
Anita Goodrum Assistant Secretary P O Box 311, Eupora, MS 39744

Filings

Type Status Filed Date Description
Dissolution Filed 2019-01-03 Dissolution For DIAZ DENTAL CLINIC, P.A.
Annual Report Filed 2018-03-30 Annual Report For DIAZ DENTAL CLINIC, P.A.
Annual Report Filed 2017-03-13 Annual Report For DIAZ DENTAL CLINIC, P.A.
Annual Report Filed 2016-04-15 Annual Report For DIAZ DENTAL CLINIC, P.A.
Annual Report Filed 2015-03-20 Annual Report For DIAZ DENTAL CLINIC, P.A.
Annual Report Filed 2014-01-22 Annual Report
Annual Report Filed 2013-04-16 Annual Report
Annual Report Filed 2012-09-28 Annual Report
Notice to Dissolve/Revoke Filed 2012-09-13 Notice to Dissolve/Revoke
Annual Report Filed 2011-04-07 Annual Report

Related by officers

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Related by address

No related companies by address

Date of last update: 08 Mar 2025

Sources: Mississippi Secretary of State

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