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PETERSON FAMILY DENTISTRY PLLC

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Company Details

Name: PETERSON FAMILY DENTISTRY PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 27 Feb 2006 (19 years ago)
Financial Date End: 28 Feb 2025
Date dissolved: 13 May 2025
Entity Number: 155560
Place of Formation: IDAHO
File Number: 155560
ZIP code: 83642
County: Ada County
Principal Address: 1859 SOUTH TOPAZ AVENUE SUITE 250 MERIDIAN, ID 83642
Mailing Address: STE 250 1859 S TOPAZ WAY MERIDIAN, ID 83642-4104

Agent

Name Role Address
JOHN G PETERSON Agent 1859 SOUTH TOPAZ WAY, SUITE 250, MERIDIAN, ID 83642

Manager

Name Role Address Appointed On
John G Peterson Manager 1859 SOUTH TOPAZ WAY, MERIDIAN, ID 83642 2021-01-05

National Provider Identifier

NPI Number:
1083873400

Authorized Person:

Name:
DR. JOHN G PETERSON
Role:
DENTIST
Phone:

Taxonomy:

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

Contacts:

Fax:
2083750305

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0006250192 2025-05-13
Annual Report 0005609003 2024-02-20
Annual Report 0005126886 2023-02-27
Annual Report 0004616017 2022-02-18
Annual Report 0004118325 2021-01-05

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Date of last update: 28 May 2025

Sources: Idaho Secretary of State