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IDAHO CENTER FOR ORAL AND FACIAL SURGERY, PLLC

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Company Details

Name: IDAHO CENTER FOR ORAL AND FACIAL SURGERY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 03 May 2010 (15 years ago)
Financial Date End: 31 May 2026
Entity Number: 288366
Place of Formation: IDAHO
File Number: 288366
ZIP code: 83201
County: Bannock County
Principal Address: 177 VISTA DR POCATELLO, ID 83201
Mailing Address: 177 VISTA DR POCATELLO, ID 83201-5824

Agent

Name Role Address
JEFFREY DABELL Agent 177 VISTA DR, POCATELLO, ID 83201

Manager

Name Role Address Appointed On Resigned On
JEFFREY DABELL Manager 177 VISTA DR, POCATELLO, ID 83201 2021-04-19 No data
HEIDI DABELL Manager 177 VISTA DR., POCATELLO, ID 83201 2024-04-16 2024-04-16

National Provider Identifier

NPI Number:
1558675298

Authorized Person:

Name:
DR. JEFFREY C DABELL
Role:
SURGEON
Phone:

Taxonomy:

Selected Taxonomy:
261QS0112X - Oral and Maxillofacial Surgery Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2082322044

Filing

Filing Name Filing Number Filing date
Annual Report 0006246267 2025-05-08
Annual Report Amendment 0006068674 2025-01-13
Annual Report 0005694569 2024-04-16
Annual Report 0005218900 2023-05-03
Annual Report 0004689160 2022-04-05

USAspending Awards / Financial Assistance

Date:
2020-04-18
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
8000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-09
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:
56000.00
Total Face Value Of Loan:
56000.00
Date:
2010-05-04
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
350000.00
Total Face Value Of Loan:
350000.00

Paycheck Protection Program

Jobs Reported:
10
Initial Approval Amount:
$56,000
Date Approved:
2020-04-09
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$56,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$56,555.4
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $42,000
Utilities: $7,000
Rent: $7,000

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Date of last update: 27 Jun 2025

Sources: Idaho Secretary of State