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FACIAL TRAUMA ASSOCIATES PLLC

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Company Details

Name: FACIAL TRAUMA ASSOCIATES PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 11 Feb 2020 (5 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 3778579
Place of Formation: IDAHO
File Number: 698676
ZIP code: 83706
County: Ada County
Principal Address: STE 103 1000 N CURTIS ROAD BOISE, ID 83706
Mailing Address: STE 103 1000 N CURTIS RD BOISE, ID 83706-1345

Agent

Name Role Address
SCOTT TUCKER Agent 1000 N CURTIS ROAD, STE 103, BOISE, ID 83706

Manager

Name Role Address Appointed On
Cole W Anderson Manager 1000 N CURTIS RD, BOISE, ID 83706-1345 2021-03-04

National Provider Identifier

NPI Number:
1568095883
Certification Date:
2020-02-14

Authorized Person:

Name:
DR. COLE W ANDERSON
Role:
MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
1223P0106X - Oral and Maxillofacial Pathology Dentist
Is Primary:
No
Selected Taxonomy:
204E00000X - Oral & Maxillofacial Surgery (D.M.D.)
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006066696 2025-01-12
Annual Report 0005567213 2024-01-20
Annual Report 0005050108 2023-01-04
Annual Report 0004657103 2022-03-12
Annual Report 0004196826 2021-03-04

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State