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Hathaway and Pelletier Family Dental, PLLC

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Company Details

Name: Hathaway and Pelletier Family Dental, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 15 Jul 2020 (5 years ago)
Financial Date End: 31 Jul 2026
Entity Number: 3940902
Place of Formation: IDAHO
File Number: 717633
ZIP code: 83616
County: Ada County
Principal Address: EVAN HATHAWAY 1217 E IRON EAGLE DR EAGLE, ID 83616
Mailing Address: EVAN HATHAWAY 1217 E IRON EAGLE DR EAGLE, ID 83616-6599

Agent

Name Role Address
Terra Alvis Agent 1200 W CHERRY LANE, STE 100, MERIDIAN, ID 83642

Manager

Name Role Address Appointed On
EVAN W HATHAWAY DDS, PLLC Manager 1217 E IRON EAGLE DR, EAGLE, ID 83616 2021-06-04

Member

Name Role Address Appointed On Resigned On
KYLE PELLETIER DMD, PLLC Member 1217 E IRON EAGLE DR, EAGLE, ID 83616 2023-08-08 2024-07-03

National Provider Identifier

NPI Number:
1790387959
Certification Date:
2020-11-12

Authorized Person:

Name:
BENJAMIN E TUINEI
Role:
CREDENTIALING MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2089380567

Filing

Filing Name Filing Number Filing date
Annual Report 0006311540 2025-06-10
Annual Report 0005797991 2024-07-03
Annual Report 0005358139 2023-08-08
Annual Report 0004773551 2022-06-07
Annual Report 0004305718 2021-06-04

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State