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Boise Premier Dentistry PLLC

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Company Details

Name: Boise Premier Dentistry PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Oct 2020 (5 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 4028809
Place of Formation: IDAHO
File Number: 729214
ZIP code: 83704
County: Ada County
Principal Address: 4598 N. CLAYTON PL. BOISE, ID 83704
Mailing Address: 4598 N CLAYTON PL BOISE, ID 83704-1235

Agent

Name Role Address
Maryam Moghaddasian Agent 4598 N CLAYTON PL, BOISE, ID 83704

Manager

Name Role Address Appointed On
Maryam Moghaddasian Manager 4598 N. CLAYTON PL, BOISE, ID 83704 2020-10-29

National Provider Identifier

NPI Number:
1689258758
Certification Date:
2021-05-05

Authorized Person:

Name:
MARYAM MOGHADDASIAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
863680861
Plan Year:
2023
Number Of Participants:
2
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005949057 2024-10-23
Annual Report 0005405938 2023-09-19
Annual Report 0004911831 2022-09-13
Annual Report 0004437506 2021-10-04
Amendment to Certificate 0004267487 2021-05-04

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State