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WHITEWATER ORAL SURGERY GROUP PLLC

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Company Details

Name: WHITEWATER ORAL SURGERY GROUP PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 24 Sep 2013 (12 years ago)
Financial Date End: 30 Sep 2026
Date dissolved: 06 Dec 2024
Entity Number: 396247
Place of Formation: IDAHO
File Number: 396247
ZIP code: 83702
County: Ada County
Mailing Address: STE 130 3003 W MAIN ST BOISE, ID 83702-2026

Agent

Name Role Address
KEVIN KEMPERS Agent 3003 W. MAIN ST, 130, BOISE, ID 83702

Manager

Name Role Address Appointed On Resigned On
KEVIN KEMPERS Manager 3003 W. MAIN STREET #130, BOISE, ID 83702 2020-08-03 2023-08-03
Kevin Kempers Manager 3003 W MAIN ST, BOISE, ID 83702 2025-08-04 No data

National Provider Identifier

NPI Number:
1104248053
Certification Date:
2020-09-04

Authorized Person:

Name:
DR. KEVIN GLENN KEMPERS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary:
No
Selected Taxonomy:
1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary:
Yes

Contacts:

Fax:
2083441799

Form 5500 Series

Employer Identification Number (EIN):
463726284
Plan Year:
2022
Number Of Participants:
42
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
37
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
32
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
34
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
33
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006380167 2025-08-04
Application for Reinstatement 0006030998 2024-12-19
Dissolution/Revocation - Administrative 0006013642 2024-12-06
Annual Report 0005344152 2023-08-03
Annual Report 0004838963 2022-08-03

USAspending Awards / Financial Assistance

Date:
2020-04-14
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:
271702.50
Total Face Value Of Loan:
271702.50
Date:
2020-04-14
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:
271702.50
Total Face Value Of Loan:
271702.50

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Date of last update: 03 Sep 2025

Sources: Idaho Secretary of State