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Perio Docs-Lewiston, PLLC

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Company Details

Name: Perio Docs-Lewiston, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 20 Aug 2019 (6 years ago)
Financial Date End: 31 Aug 2022
Date dissolved: 05 Nov 2022
Entity Number: 3601169
Place of Formation: IDAHO
File Number: 677693
ZIP code: 83501
County: Nez Perce County
Principal Address: 3323 4TH ST LEWISTON, ID 83501-4423
Mailing Address: STE 110 3323 4TH ST LEWISTON, ID 83501-4423

Agent

Name Role Address
WILLARD W MAUGHAN, DDS Agent 3323 4TH ST, LEWISTON, ID 83501

Manager

Name Role Address Appointed On
David W Engen Manager 9911 N NEVADA ST STE 110, SPOKANE, WA 99218 2021-09-02
David W Engen DDS Manager 9911 N NEVADA ST STE 110, SPOKANE, WA 99218 2020-09-04

National Provider Identifier

NPI Number:
1235895160
Certification Date:
2021-11-22

Authorized Person:

Name:
AMANDA D AIKEN
Role:
BUSINESS MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2087433029

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0004978542 2022-11-05
Annual Report 0004398576 2021-09-02
Annual Report 0003997033 2020-09-04
Change of Registered Office/Agent/Both (by Entity) 0003678511 2019-11-15
Amendment to Certificate 0003678487 2019-11-15

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Date of last update: 17 May 2025

Sources: Idaho Secretary of State