0001209191-18-038455.txt : 20180619
0001209191-18-038455.hdr.sgml : 20180619
20180619105747
ACCESSION NUMBER: 0001209191-18-038455
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20180615
FILED AS OF DATE: 20180619
DATE AS OF CHANGE: 20180619
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Norbe Todd
CENTRAL INDEX KEY: 0001743526
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 18906487
MAIL ADDRESS:
STREET 1: 7 RUNNING BROOK DRIVE
CITY: TRABUCO CANYON
STATE: CA
ZIP: 92679
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2018-06-15
1
0000811240
BIOLASE, INC
BIOL
0001743526
Norbe Todd
4 CROMWELL
IRVINE
CA
92618
1
0
0
0
No securities are beneficially owned.
/s/ Michael C. Carroll, attorney-in-fact for Todd Norbe
2018-06-19
EX-24.3_797218
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby authorizes Michael C.
Carroll to execute for and on behalf of the undersigned, in the undersigned's
capacity as a Section 16 reporting person of Biolase Technology, Inc., a
Delaware corporation (the "Company"), EDGAR Form ID (including amendments
thereto) and Authenticating Statements, Forms 3, 4 and 5, and any amendments
thereto, and cause such form(s) to be filed with the United States Securities
and Exchange Commission and The NASDAQ Stock Market. The undersigned hereby
grants to such attorney-in-fact full power and authority to do and perform any
and every act and thing whatsoever requisite, necessary, or proper to be done in
exercise of any of the rights and powers herein granted, as fully to all intents
and purposes as the undersigned might or could do if personally present, with
full power of substitution or revocation, hereby ratifying and confirming all
that such attorney-in-fact, or such attorney-in-fact's substitute or
substitutes, shall lawfully do or cause to be done by virtue of this power of
attorney and the rights and powers herein granted.
The undersigned acknowledges that the foregoing attorney-in-fact, in serving in
such capacity at the request of the undersigned, is not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934, as amended or the rules
promulgated thereunder.
This Limited Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of, and transactions in, securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered
to the foregoing attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has cause this Power of Attorney to be
executed as of this 18th day of June, 2018.
By: /s/ Todd Norbe
Print Name: Todd Norbe