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Eagle Dental Partnership PLLC

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Company Details

Name: Eagle Dental Partnership PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Feb 2019 (6 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 3432095
Place of Formation: IDAHO
File Number: 655153
ZIP code: 83642
County: Ada County
Principal Address: 3850 E MACKAY CT MERIDIAN, ID 83642
Mailing Address: TYSON GRAY 577 E STATE ST EAGLE, ID 83616-5938

Agent

Name Role Address
CAMERON KELLER Agent 2361 S TITANIUM PL STE 100, MERDIIAN, ID 83642

Member

Name Role Address Appointed On Resigned On
Gray Team LLC Member 3850 E MACKAY CT, MERIDIAN, ID 83642 2022-05-31 No data
Tyson Gray Member 3850 E MACKAY CT, MERIDIAN, ID 83642 2021-05-05 2022-05-31

National Provider Identifier

NPI Number:
1639732399

Authorized Person:

Name:
KARLA PICCIOTTI
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
2083452008

Form 5500 Series

Employer Identification Number (EIN):
833610001
Plan Year:
2023
Number Of Participants:
7
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006074477 2025-01-18
Amendment to Certificate 0005636534 2024-03-05
Annual Report 0005551826 2024-01-09
Annual Report 0005054329 2023-01-05
Application for Reinstatement 0004759711 2022-05-31

USAspending Awards / Financial Assistance

Date:
2020-04-28
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:
21400.00
Total Face Value Of Loan:
21400.00

Paycheck Protection Program

Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
21400
Current Approval Amount:
21400
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
21560.65

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Date of last update: 17 May 2025

Sources: Idaho Secretary of State