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LAKE HARBOR DENTAL

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Company Details

Name: LAKE HARBOR DENTAL
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 29 Nov 2005 (20 years ago)
Entity Number: 291607
Place of Formation: IDAHO
File Number: 0000291607
ZIP code: 83703
County: Ada County
Mailing Address: 5355 W STATE ST BOISE, ID 83703

National Provider Identifier

NPI Number:
1639310089

Authorized Person:

Name:
MR. MICHAEL EUGENE PETERSON
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
No
Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
2088534690

Form 5500 Series

Employer Identification Number (EIN):
464776064
Plan Year:
2023
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
12
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000291607 2005-11-29

USAspending Awards / Financial Assistance

Date:
2020-05-17
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

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State