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LIGHTHOUSE DENTAL GROUP, PLLC

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Company Details

Name: LIGHTHOUSE DENTAL GROUP, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 31 Dec 2009 (15 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 278061
Place of Formation: IDAHO
File Number: 278061
ZIP code: 83616
County: Ada County
Principal Address: 1177 N EAGLE RD EAGLE, ID 83616
Mailing Address: 1177 N EAGLE RD EAGLE, ID 83616-5017

Member

Name Role Address Appointed On Resigned On
Michael Higginson Member 1177 N EAGLE RD, EAGLE, ID 83616 2020-12-09 2023-11-06
Marvin Oto Member 1177 N EAGLE RD, EAGLE, ID 83616 2023-11-06 No data
Brian Jensen Member 1177 N EAGLE RD, EAGLE, ID 83616 2023-11-06 2023-11-06

Agent

Name Role Address
Brian C Jensen Agent 1177 N EAGLE ROAD, EAGLE, ID 83616

National Provider Identifier

NPI Number:
1174631287

Authorized Person:

Name:
MR. MICHAEL LYNN HIGGINSON
Role:
PARTNER/DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
No
Selected Taxonomy:
122300000X - Dentist
Is Primary:
No
Selected Taxonomy:
122300000X - Dentist
Is Primary:
No
Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
2089393027

Form 5500 Series

Employer Identification Number (EIN):
271467916
Plan Year:
2023
Number Of Participants:
57
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
57
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
38
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
27
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
23
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005974776 2024-11-08
Change of Registered Office/Agent/Both (by Entity) 0005950776 2024-10-25
Annual Report 0005466711 2023-11-06
Annual Report 0004985376 2022-11-07
Dissolution/Revocation - Administrative 0004667994 2022-03-23

USAspending Awards / Financial Assistance

Date:
2020-04-28
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:
145900.00
Total Face Value Of Loan:
145900.00

Paycheck Protection Program

Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
145900
Current Approval Amount:
145900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
147199.11

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Date of last update: 31 May 2025

Sources: Idaho Secretary of State