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IDAHO ORAL SURGERY PLLC

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Company Details

Name: IDAHO ORAL SURGERY PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 29 Jan 2007 (19 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 187202
Place of Formation: IDAHO
File Number: 187202
ZIP code: 83619
County: Payette County
Principal Address: 1820 N WHITLEY DR FRUITLAND, ID 83619
Mailing Address: 1820 N WHITLEY DR FRUITLAND, ID 83619-2108

Agent

Name Role Address
Ryan Hillam Agent 1820 N WHITLEY DR, FRUITLAND, ID 83619

Member

Name Role Address Appointed On Resigned On
Ryan Hillam Member 1820 N WHITLEY DR, FRUITLAND, ID 83619-2108 2020-12-10 2024-01-30

Manager

Name Role Address Appointed On
Ryan Hillam Manager 1820 N WHITLEY DR, FRUITLAND, ID 83619-2108 2024-01-30

National Provider Identifier

NPI Number:
1912172958

Authorized Person:

Name:
RYAN DAVID HILLAM
Role:
SURGEON
Phone:

Taxonomy:

Selected Taxonomy:
302F00000X - Exclusive Provider Organization
Is Primary:
Yes

Contacts:

Fax:
2084526617

Filing

Filing Name Filing Number Filing date
Annual Report 0006128445 2025-02-25
Annual Report 0005575561 2024-01-30
Annual Report 0005018461 2022-12-07
Annual Report 0004603872 2022-02-10
Annual Report 0004097456 2020-12-10

USAspending Awards / Financial Assistance

Date:
2020-04-16
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:
39329.60
Total Face Value Of Loan:
39329.60

Paycheck Protection Program

Jobs Reported:
6
Initial Approval Amount:
$39,329.6
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$39,329.6
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$39,787.55
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $39,329.6

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Date of last update: 29 Aug 2025

Sources: Idaho Secretary of State