GALLERY OF COSMETIC SURGERY, PLLC

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Company Details

Legal Name:	GALLERY OF COSMETIC SURGERY, PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	September 27th 2005
Expiration date:	30 Sep 2017
UBI Number:	602 552 577
ZIP code:	98101
City:	Seattle
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	509 OLIVE WY STE 1434, SEATTLE, WA, 98101, UNITED STATES

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Registered Agent Information

Name	Role	Address
D EDSON CLARK	Registered Agent	8350 164TH AVE NE STE 200, REDMOND, WA, 98052-0000, UNITED STATES

Key Officers & Management

Name	Role
CRAIG JONOV	Governing Person

National Provider Identifier

NPI Number:

1861606162

Link:

View on NPI website

Authorized Person:

Name:

DYANNE K MIDDAUGH

Role:

PRACTICE MANAGER

Phone:

4257753561

Taxonomy:

Selected Taxonomy:

174400000X - Specialist

Is Primary:

Yes

Contacts:

Phone:

+1 425-775-3561

Fax:

4256721385

Form 5500 Series

Employer Identification Number (EIN):

203518190

Plan Year:

2017

Number Of Participants:

11

Sponsor's telephone number:

4257753561

File:

Plan Year:

2017

Number Of Participants:

6

Sponsor's telephone number:

4257753561

File:

Plan Year:

2016

Number Of Participants:

12

Sponsor's telephone number:

4257753561

File:

Plan Year:

2015

Number Of Participants:

13

Sponsor's telephone number:

4257753561

File:

Plan Year:

2014

Number Of Participants:

14

Sponsor's telephone number:

4257753561

File:

Plan Administrator / Signatory:

CRAIG R. JONOV, MD(Plan administrator)

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