0001209191-11-045233.txt : 20110822 0001209191-11-045233.hdr.sgml : 20110822 20110822172330 ACCESSION NUMBER: 0001209191-11-045233 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110818 FILED AS OF DATE: 20110822 DATE AS OF CHANGE: 20110822 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Arrow Alexander K. CENTRAL INDEX KEY: 0001497166 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 111050586 MAIL ADDRESS: STREET 1: PO BOX 3094 CITY: REDWOOD CITY STATE: CA ZIP: 94064 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BIOLASE TECHNOLOGY 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: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 949-361-1200 MAIL ADDRESS: STREET 1: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 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 FORMER COMPANY: FORMER CONFORMED NAME: PAMPLONA CAPITAL CORP DATE OF NAME CHANGE: 19911104 4 1 doc4.xml FORM 4 SUBMISSION X0304 4 2011-08-18 0 0000811240 BIOLASE TECHNOLOGY INC BLTI 0001497166 Arrow Alexander K. C/O 4 CROMWELL IRVINE CA 92618 1 0 0 0 Common Stock 2011-08-18 4 P 0 5000 2.84 A 48775 D Includes 275 shares which were received from Biolase Technology, Inc. as stock dividends, consisting of 30 shares received on March 31, 2011 and 245 shares received on June 30, 2011. /s/ Michael C. Carroll, Attorney-in-Fact for Alexander K. Arrow 2011-08-22