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EMERALD WEST FAMILY DENTISTRY, PLLC

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Company Details

Name: EMERALD WEST FAMILY DENTISTRY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 30 Dec 1997 (28 years ago)
Financial Date End: 31 Dec 2024
Date dissolved: 18 Nov 2024
Entity Number: 30038
Place of Formation: IDAHO
File Number: 30038
ZIP code: 83704
County: Ada County
Principal Address: 8850 W EMERALD 150 BOISE, ID 83704
Mailing Address: STE 150 8850 W EMERALD ST BOISE, ID 83704-4809

Agent

Name Role Address
CHAD D HESS, D.D.S Agent 8850 W EMERALD, 150, BOISE, ID 83704

Manager

Name Role Address Appointed On Resigned On
J Randall Moss Manager 8850 W EMERALD #150, BOISE, ID 83704 2020-12-14 2023-04-18

Member

Name Role Address Appointed On
J Randall Moss Member 8850 W EMERALD ST, BOISE, ID 83704-4809 2023-04-18
Chad D Hess Member 8850 W EMERALD ST, BOISE, ID 83704-4809 2023-12-28

National Provider Identifier

NPI Number:
1639238124

Authorized Person:

Name:
MRS. JAYNE BLAZEK
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
2083232299

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0005987359 2024-11-18
Annual Report 0005528590 2023-12-28
Application for Reinstatement 0005204355 2023-04-18
Dissolution/Revocation - Administrative 0005144309 2023-03-08
Annual Report 0004523890 2021-12-09

USAspending Awards / Financial Assistance

Date:
2020-04-14
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:
128695.00
Total Face Value Of Loan:
128695.00
Date:
2015-07-22
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:
2915000.00
Total Face Value Of Loan:
2997564.00

Paycheck Protection Program

Jobs Reported:
15
Initial Approval Amount:
$128,695
Date Approved:
2020-04-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$128,695
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Unanswered
Forgiveness Amount:
$130,549.62
Servicing Lender:
KeyBank National Association
Use of Proceeds:
Payroll: $128,695

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Date of last update: 13 Jul 2025

Sources: Idaho Secretary of State