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Portneuf Valley Dental PLLC

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Company Details

Name: Portneuf Valley Dental PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 10 Oct 2019 (6 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 3646681
Place of Formation: IDAHO
File Number: 683722
ZIP code: 83201
County: Bannock County
Principal Address: DR JAYSON BIRD 1246 YELLOWSTONE AVE POCATELLO, ID 83201
Mailing Address: DR TANNER HIGHAM #D3 1246 YELLOWSTONE AVE POCATELLO, ID 83201-4374

Agent

Name Role Address
TANNER HIGHAM Agent 1246 YELLOWSTONE AVE, STE D3, POCATELLO, ID 83201

Member

Name Role Address Appointed On Resigned On
Tanner Higham Member 1246 YELLOWSTONE AVE, POCATELLO, ID 83201-4374 2021-12-03 No data
Jayson Bird Member 5215 SOLSTICE LANE, IDAHO FALLS, ID 83404 2020-09-03 2021-12-03

National Provider Identifier

NPI Number:
1770127565

Authorized Person:

Name:
JAYSON ANDERS BIRD
Role:
CEO/OWNER
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005895066 2024-09-09
Annual Report 0005420632 2023-10-03
Annual Report 0004965989 2022-11-01
Annual Report 0004514956 2021-12-03
Statement of Rescission of Dissolution (LLC) 0004510282 2021-12-01

USAspending Awards / Financial Assistance

Date:
2020-04-07
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:
17800.00
Total Face Value Of Loan:
17800.00

Paycheck Protection Program

Date Approved:
2020-04-04
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
17800
Current Approval Amount:
17800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
17962.18

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Date of last update: 17 May 2025

Sources: Idaho Secretary of State