Skip To The Main Content

Polk County Dental Association

Dr. Max Forni, PRESIDENT 
701 FL-60, Lake Wales 33853
863-676-6021
drforni@outlook.com

*Dr. Samuel Pero, PRESIDENT ELECT AND PROGRAM CHAIR
701 FL-60, Lake Wales 33853
863-676-6021
samperoiv@gmail.com

Dr. Annie Siassipour, FIRST VICE-PRESIDENT 
701 FL-60, Lake Wales 33853
863/676-6021
annie.siassipour@gmail.com

Dr. Jonathan Scott, SECRETARY
5110 South Lakeland Drive, Lakeland 33813
863/709-1941 
jds@scottsmiles.com

Dr. Charles D. Llano, Treasurer
320 West Highland Drive, Lakeland 33813
863/668-8222
lakelanddds@gmail.com

Ms. Susan Rexroat, GIVE KIDS A SMILE CONTACT PERSON
3225 Winter Lake Road, Lakeland 33803
863/499-2700
FAX 863/497-2706
susan.rexroat@polk-fl.net

Ms. Tisha Talbot, EXECUTIVE SECRETARY
1132 Maplebrook Drive, Lake Alfred 33850
863/236-7610
pcdaemail@gmail.com

*Christopher M. Bulnes, DMD, WCDDA OFFICER LIAISON
3906 West Neptune Street, Tampa 33629
813/259-9000 
FAX 813/259-9923
trimile26@gmail.com
"Local":"WestCoastDistrictFL"