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ID Specialty Dental Services, PLLC

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Company Details

Name: ID Specialty Dental Services, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 09 Sep 2020 (5 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 4000390
Place of Formation: IDAHO
File Number: 725035
ZIP code: 83642
County: Ada County
Principal Address: 1200 CHERRY LANE MERIDIAN, ID 83642
Mailing Address: CHRIS SCALES STE 205 1610 54TH AVE N NASHVILLE, TN 37209-1442

Agent

Name Role Address
REGISTERED AGENT SOLUTIONS, INC. Agent 10020 W FAIRVIEW AVE, STE 104, BOISE, ID 83704

Member

Name Role Address Appointed On
Chad Lambourne Member 4467 RIDGEWOOD LN S, BILLINGS, MT 59106 2021-09-07

National Provider Identifier

NPI Number:
1013757830
Certification Date:
2024-05-29

Authorized Person:

Name:
CHARLOTTE DASCH
Role:
DIRECTOR OF CRED AND PROV REL
Phone:

Taxonomy:

Selected Taxonomy:
1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Registered Agent Name/Address Change (mass change) 0006283598 2025-05-27
Annual Report 0005840312 2024-08-05
Annual Report 0005343934 2023-08-03
Registered Agent Name/Address Change (mass change) 0004908995 2022-09-12
Annual Report 0004852323 2022-08-08

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State