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WAYNE PETERSON, D.M.D. P.C.

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Company Details

Name: WAYNE PETERSON, D.M.D. P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 24 May 1999 (26 years ago)
Financial Date End: 31 May 2024
Date dissolved: 13 Aug 2024
Entity Number: 394695
Place of Formation: IDAHO
File Number: 394695
ZIP code: 83843
County: Latah County
Mailing Address: WAYNE PETERSON 2547 WEYMOUTH ST MOSCOW, ID 83843-9616

Agent

Name Role Address
WAYNE PETERSON Agent 2547 WEYMOUTH ST., MOSCOW, ID 83843

President

Name Role Address Appointed On
WAYNE M PETERSON President 2547 WEYMOUTH ST., MOSCOW, ID 83843 2021-04-05

National Provider Identifier

NPI Number:
1134389281

Authorized Person:

Name:
DR. WAYNE MICHAEL PETERSON
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
2088828601

Form 5500 Series

Employer Identification Number (EIN):
820513128
Plan Year:
2011
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
6
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005858864 2024-08-13
Annual Report 0005202075 2023-04-14
Annual Report 0004685227 2022-04-04
Annual Report 0004229624 2021-04-05
Annual Report 0003843464 2020-04-12

Paycheck Protection Program

Jobs Reported:
4
Initial Approval Amount:
$53,000
Date Approved:
2020-04-27
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$53,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$53,537.26
Servicing Lender:
Banner Bank
Use of Proceeds:
Payroll: $53,000

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Date of last update: 07 Aug 2025

Sources: Idaho Secretary of State