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CHILDREN'S DENTISTRY OF IDAHO, PLLC

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Company Details

Name: CHILDREN'S DENTISTRY OF IDAHO, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 21 Nov 2011 (14 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 334498
Place of Formation: IDAHO
File Number: 334498
ZIP code: 83686
County: Canyon County
Principal Address: 349 W IOWA AVE NAMPA, ID 83686
Mailing Address: 349 W IOWA AVE NAMPA, ID 83686-2856

Agent

Name Role Address
Michael Pysnak Agent 349 W IOWA AVE, NAMPA, ID 83686

Manager

Name Role Address Appointed On Resigned On
Childrens Dentistry of Idaho Manager 349 W IOWA AVE, NAMPA, ID 83686 2020-08-12 2020-11-19
Rachel Mitchell Manager 349 W IOWA AVE, NAMPA, ID 83686 2020-11-19 No data

National Provider Identifier

NPI Number:
1689942849
Certification Date:
2021-11-08

Authorized Person:

Name:
JEFFREY BRYSON
Role:
OWNER/DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
1223P0221X - Pediatric Dentist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005930779 2024-10-07
Annual Report 0005436259 2023-10-09
Annual Report 0004937436 2022-10-05
Annual Report 0004491849 2021-11-08
Change of Registered Office/Agent/Both (by Entity) 0004220316 2021-03-26

Paycheck Protection Program

Jobs Reported:
27
Initial Approval Amount:
$180,782
Date Approved:
2021-02-10
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$180,782
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$182,114.34
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $180,780
Utilities: $1
Jobs Reported:
18
Initial Approval Amount:
$180,781
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$180,781
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$181,855.78
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $180,781

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Date of last update: 19 Jul 2025

Sources: Idaho Secretary of State