0002004245-26-000001.txt : 20260722 0002004245-26-000001.hdr.sgml : 20260722 20260722112751 ACCESSION NUMBER: 0002004245-26-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 506(b) provides a "safer harbor" for a private offering FILED AS OF DATE: 20260722 DATE AS OF CHANGE: 20260722 EFFECTIVENESS DATE: 20260722 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Providence Dental Partners LLC CENTRAL INDEX KEY: 0002004245 ORGANIZATION NAME: EIN: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-500803 FILM NUMBER: 261192643 BUSINESS ADDRESS: STREET 1: 1000 WILLIAMS MILL ROAD NE CITY: ATLANTA STATE: GA ZIP: 30306 BUSINESS PHONE: (616) 308-5125 MAIL ADDRESS: STREET 1: 1000 WILLIAMS MILL ROAD NE CITY: ATLANTA STATE: GA ZIP: 30306 D/A 1 primary_doc.xml X0708 D/A LIVE 0002004245 Providence Dental Partners LLC 1000 WILLIAMS MILL ROAD NE ATLANTA GA GEORGIA 30306 (616) 308-5125 DELAWARE None None Limited Liability Company true 2023 Salem VanderStel 1000 Williams Mill Road NE Atlanta GA GEORGIA 30306 Promoter Steve Lyman 1000 Williams Mill Road NE Atlanta GA GEORGIA 30306 Promoter Mark DeMonaco 1000 Williams Mill Road NE Atlanta GA GEORGIA 30306 Promoter Andrew Goldberger 1000 Williams Mill Road NE Atlanta GA GEORGIA 30306 Promoter Other Health Care Decline to Disclose 06b true 0002004245-23-000001 2023-12-11 true true false 100000 100000000 33904225 66095775 true 0 142 0 0 3000000 Acquisition Fee(s) false Providence Dental Partners LLC /s/ Salem VanderStel Salem VanderStel Manager of the Manger 2026-07-22