0001209191-12-043026.txt : 20120823 0001209191-12-043026.hdr.sgml : 20120823 20120823174647 ACCESSION NUMBER: 0001209191-12-043026 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120821 FILED AS OF DATE: 20120823 DATE AS OF CHANGE: 20120823 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Furry Frederick D. CENTRAL INDEX KEY: 0001507429 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 121052867 MAIL ADDRESS: STREET 1: 18372 OXBORO LANE CITY: HUNTINGTON BEACH STATE: CA ZIP: 92648 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: 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: 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 2012-08-21 0 0000811240 BIOLASE, INC BIOL 0001507429 Furry Frederick D. C/O 4 CROMWELL IRVINE CA 92618 0 1 0 0 Chief Financial Officer Common Stock 2012-08-21 4 P 0 4000 1.64 A 4000 D Common Stock 2012-08-23 4 P 0 1000 1.65 A 5000 D /s/ Michael C. Carroll, attorney-in-fact for Frederick D. Furry 2012-08-23