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KEVIN MUDROW, DDS, PLLC

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Company Details

Name: KEVIN MUDROW, DDS, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 28 Aug 2013 (12 years ago)
Financial Date End: 31 Aug 2019
Date dissolved: 25 Nov 2019
Entity Number: 393405
Place of Formation: IDAHO
File Number: 393405
ZIP code: 83401
County: Bonneville County
Principal Address: 333 S WOODRUFF AVE IDAHO FALLS, ID 83401

Agent

Name Role Address
KEVIN MUDROW, DDS Agent 333 S WOODRUFF AVE, IDAHO FALLS, ID 83401

National Provider Identifier

NPI Number:
1235565003

Authorized Person:

Name:
DR. KEVIN RICHARD MUDROW
Role:
OWNER/GENERAL DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
463567415
Plan Year:
2020
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
3
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0003684757 2019-11-25
Annual Report 0002687565 2018-06-25
Annual Report 0002687564 2017-06-19
Annual Report 0002687563 2016-09-20
Annual Report 0002687562 2015-06-27

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Date of last update: 04 Jun 2025

Sources: Idaho Secretary of State