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MADISON PARK DENTAL CENTER, PLLC

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Company Details

Name: MADISON PARK DENTAL CENTER, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 Jul 2004 (21 years ago)
Financial Date End: 31 Jul 2026
Entity Number: 107959
Place of Formation: IDAHO
File Number: 107959
ZIP code: 83440
County: Madison County
Principal Address: 345 N 2ND E STE 2 REXBURG, ID 83440
Mailing Address: STE 2 345 N 2ND E REXBURG, ID 83440-1603

Agent

Name Role Address
Daniel Packard Agent 1000 RIVERWALK DRIVE, 100, IDAHO FALLS, ID 83402

Manager

Name Role Address Appointed On
Matthew Griffeth Manager 345 N 2ND E, REXBURG, ID 83440 2020-07-23

National Provider Identifier

NPI Number:
1831545102

Authorized Person:

Name:
DR. MARK A TALL
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
No
Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
2083568788

Filing

Filing Name Filing Number Filing date
Annual Report 0006291676 2025-06-02
Annual Report 0005755814 2024-06-03
Annual Report 0005755727 2024-06-03
Annual Report 0005269708 2023-06-06
Annual Report 0004762294 2022-06-01

USAspending Awards / Financial Assistance

Date:
2020-04-28
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
23000.00
Total Face Value Of Loan:
23000.00
Date:
2020-04-17
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
5000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2008-02-19
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
-100000.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Jobs Reported:
4
Initial Approval Amount:
$23,000
Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$23,000
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$23,233.15
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $17,250
Utilities: $2,875
Rent: $2,875

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Date of last update: 15 Jul 2025

Sources: Idaho Secretary of State