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SOUTHRIDGE DENTAL

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Company Details

Name: SOUTHRIDGE DENTAL
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 21 Nov 2000 (25 years ago)
Entity Number: 134330
Place of Formation: IDAHO
File Number: 0000134330
ZIP code: 83686
County: Canyon County
Mailing Address: 2811 12TH AVE RD NAMPA, ID 83686

National Provider Identifier

NPI Number:
1891954343

Authorized Person:

Name:
DR. ROBERT ALAN PRATT
Role:
DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
2084656303

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0000736079 2012-02-14
Amendment of Certificate of Assumed Business Name 0000736078 2004-12-23
Initial Filing 0000134330 2000-11-21

USAspending Awards / Financial Assistance

Date:
2020-04-22
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
10000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State