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SOUTHEAST IDAHO ORTHODONTICS, PLLC

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Company Details

Name: SOUTHEAST IDAHO ORTHODONTICS, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Dec 2005 (19 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 147656
Place of Formation: IDAHO
File Number: 147656
ZIP code: 83201
County: Bannock County
Principal Address: 625 E. ALAMEDA RD POCATELLO, ID 83201
Mailing Address: 625 E ALAMEDA RD POCATELLO, ID 83201-3622

Agent

Name Role Address
ERIC L OLSEN Agent 505 PERSHING AVE, POCATELLO, ID 83201

Member

Name Role Address Appointed On Resigned On
Jeff McMinn Member 625 E ALAMEDA RD, POCATELLO, ID 83201 2020-11-16 2023-03-14
Brown Orthodontics, PLLC Member 625 E ALAMEDA RD, POCATELLO, ID 83201-3622 2023-03-14 No data
McMinn Orthodontics, INC. Member 625 E ALAMEDA RD, POCATELLO, ID 83201-3622 2023-11-03 2023-11-03

National Provider Identifier

NPI Number:
1508080599

Authorized Person:

Name:
DR. ERIC D JOHNSON
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
Is Primary:
Yes

Contacts:

Fax:
2082377982

Form 5500 Series

Employer Identification Number (EIN):
203946735
Plan Year:
2022
Number Of Participants:
34
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
28
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
25
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
26
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
20
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005967944 2024-11-06
Annual Report 0005459636 2023-11-03
Application for Reinstatement 0005152369 2023-03-14
Dissolution/Revocation - Administrative 0005144392 2023-03-08
Annual Report 0004488599 2021-11-05

USAspending Awards / Financial Assistance

Date:
2020-04-15
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:
107700.00
Total Face Value Of Loan:
107700.00

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Date of last update: 27 May 2025

Sources: Idaho Secretary of State