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IDAHO FALLS DENTAL GROUP, PLLC

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Company Details

Name: IDAHO FALLS DENTAL GROUP, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 29 Aug 1984 (41 years ago)
Financial Date End: 31 Aug 2026
Entity Number: 240227
Place of Formation: IDAHO
File Number: 240227
ZIP code: 83404
County: Bonneville County
Principal Address: 3830 S 25TH E IDAHO FALLS, ID 83404
Mailing Address: STE 100 3830 S 25TH E IDAHO FALLS, ID 83404-4983

Agent

Name Role Address
DEVIN THOMPSON Agent 3830 S 25TH E, IDAHO FALLS, ID 83404

Manager

Name Role Address Appointed On Resigned On
DEVIN THOMPSON Manager 3830 SOUTH 25TH EAST, IDAHO FALLS, ID 83404 2022-05-24 No data
Blake Barney Manager 3830 S 25TH E, IDAHO FALLS, ID 83404 2023-07-06 2024-07-11
Christopher Rhees Manager 3830 S 25TH E, IDAHO FALLS, ID 83404 2023-07-06 2024-07-11
Jason Scoresby Manager 3830 S 25TH E, IDAHO FALLS, ID 83404 2023-07-06 2024-07-11
Joseph Yates Manager 3830 S 25TH E, IDAHO FALLS, ID 83404 2023-07-06 2024-07-11

Governor

Name Role Address Appointed On Resigned On
DEVIN THOMPSON Governor 3830 SOUTH 25TH EAST, IDAHO FALLS, ID 83404 2021-12-14 2022-05-24

Secretary

Name Role Address Appointed On Resigned On
Blake Barney Secretary 3830 S 25TH E, IDAHO FALLS, ID 83404 2020-11-05 2021-12-14

National Provider Identifier

NPI Number:
1497803696

Authorized Person:

Name:
TRACY LARSEN
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
2085236419

Filing

Filing Name Filing Number Filing date
Annual Report 0006339286 2025-07-03
Annual Report 0005816644 2024-07-11
Annual Report 0005307472 2023-07-06
Annual Report 0004808984 2022-07-08
Amendment to Certificate 0004756670 2022-05-24

USAspending Awards / Financial Assistance

Date:
2020-04-23
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
Date:
2020-04-13
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:
414800.00
Total Face Value Of Loan:
414800.00

Paycheck Protection Program

Jobs Reported:
27
Initial Approval Amount:
$414,800
Date Approved:
2020-04-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$414,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$417,488.72
Servicing Lender:
KeyBank National Association
Use of Proceeds:
Payroll: $414,800

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Date of last update: 17 Jul 2025

Sources: Idaho Secretary of State