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CHILDREN'S DENTISTRY, PLLC

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Company Details

Name: CHILDREN'S DENTISTRY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 10 May 2012 (13 years ago)
Financial Date End: 31 May 2025
Entity Number: 350275
Place of Formation: IDAHO
File Number: 350275
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
JEFFREY BRYSON Agent 349 W IOWA AVE, NAMPA, ID 83686

Manager

Name Role Address Appointed On
Rachel Mitchell Manager 349 W IOWA AVE, NAMPA, ID 83686 2021-06-07

National Provider Identifier

NPI Number:
1932372026

Authorized Person:

Name:
DR. KEVIN KIZER
Role:
PEDIATRIC DENTIST
Phone:

Taxonomy:

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

Contacts:

Fax:
2084675199

Filing

Filing Name Filing Number Filing date
Annual Report 0005773680 2024-06-11
Annual Report 0005180736 2023-04-04
Annual Report 0004772156 2022-06-06
Application for Reinstatement 0004308606 2021-06-07
Dissolution/Revocation - Administrative 0003599233 2019-08-20

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Date of last update: 08 May 2025

Sources: Idaho Secretary of State