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MICHAEL A. BLOOM, DMD, PLLC

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Company Details

Name: MICHAEL A. BLOOM, DMD, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 15 Dec 2004 (21 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 118033
Place of Formation: IDAHO
File Number: 118033
ZIP code: 83814
County: Kootenai County
Principal Address: 110 E WALLACE AVE COEUR D ALENE, ID 83814
Mailing Address: STE 301 505 E FRONT AVE COEUR D ALENE, ID 83814-2776

Agent

Name Role Address
PAUL W DAUGHARTY Agent 505 E FRONT STREET, SUITE 301, COEUR D ALENE, ID 83814

Member

Name Role Address Appointed On
MICHAEL A BLOOM DMD Member 9928 N GOVERNMENT WAY, HAYDEN, ID 83835 2023-12-20

National Provider Identifier

NPI Number:
1033554845

Authorized Person:

Name:
MRS. KATHY L. MARKS
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
No
Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
Yes

Contacts:

Fax:
2087723224

Form 5500 Series

Employer Identification Number (EIN):
421654720
Plan Year:
2023
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
9
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006028913 2024-12-17
Annual Report 0005524050 2023-12-20
Annual Report 0003660242 2019-11-01
Change of Registered Office/Agent/Both (by Entity) 0003445082 2019-03-07
Statement of Change of Business Mailing Address 0003445186 2019-03-07

USAspending Awards / Financial Assistance

Date:
2020-04-07
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:
97800.00
Total Face Value Of Loan:
97800.00

Paycheck Protection Program

Jobs Reported:
11
Initial Approval Amount:
$97,800
Date Approved:
2020-04-04
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$97,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$98,682.92
Servicing Lender:
bankcda
Use of Proceeds:
Payroll: $97,800

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Date of last update: 15 Jul 2025

Sources: Idaho Secretary of State