0001209191-21-070069.txt : 20211216 0001209191-21-070069.hdr.sgml : 20211216 20211216183852 ACCESSION NUMBER: 0001209191-21-070069 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211215 FILED AS OF DATE: 20211216 DATE AS OF CHANGE: 20211216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LORD JONATHAN T MD CENTRAL INDEX KEY: 0001112980 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 211499078 MAIL ADDRESS: STREET 1: 500 WEST MAIN ST. CITY: LOUISVILLE STATE: KY ZIP: 40202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BIOLASE, INC CENTRAL INDEX KEY: 0000811240 STANDARD INDUSTRIAL CLASSIFICATION: DENTAL EQUIPMENT & SUPPLIES [3843] IRS NUMBER: 870442441 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 27042 TOWNE CENTRE DRIVE STREET 2: SUITE 270 CITY: FOOTHILL RANCH STATE: CA ZIP: 92610 BUSINESS PHONE: 949-361-1200 MAIL ADDRESS: STREET 1: 27042 TOWNE CENTRE DRIVE STREET 2: SUITE 270 CITY: FOOTHILL RANCH STATE: CA ZIP: 92610 FORMER COMPANY: FORMER CONFORMED NAME: BIOLASE TECHNOLOGY INC DATE OF NAME CHANGE: 19941117 FORMER COMPANY: FORMER CONFORMED NAME: LASER MEDICAL TECHNOLOGY INC DATE OF NAME CHANGE: 19941117 FORMER COMPANY: FORMER CONFORMED NAME: LASER ENDO TECHNIC CORP DATE OF NAME CHANGE: 19920708 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-12-15 0 0000811240 BIOLASE, INC BIOL 0001112980 LORD JONATHAN T MD 27042 TOWNE CENTRE DR. SUITE 270 FOOTHILL RANCH CA 92610 1 0 0 0 Common Stock 2021-12-15 4 S 0 11038 0.38 D 633096 D /s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord 2021-12-16