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WILLOW TREE DENTAL GROUP, PLLC

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Company Details

Name: WILLOW TREE DENTAL GROUP, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 19 Dec 1997 (28 years ago)
Financial Date End: 31 Dec 2017
Date dissolved: 05 Oct 2017
Entity Number: 29702
Place of Formation: IDAHO
File Number: 0000029702
ZIP code: 83704
County: Ada County
Principal Address: 8020 W BURNTREE CT BOISE, ID 83704

National Provider Identifier

NPI Number:
1093974446

Authorized Person:

Name:
MRS. SHANNON LOVE
Role:
FINANCIAL MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223P0300X - Periodontist
Is Primary:
Yes

Contacts:

Fax:
2083452601

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0000654558 2017-10-05
Annual Report 0001035844 2017-03-07
Legacy Amendment 0000654557 2017-03-07
Annual Report 0001035843 2015-12-16
Annual Report 0001035842 2014-10-14

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Date of last update: 22 Sep 2024

Sources: Idaho Secretary of State