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  5. LAKE HARBOR DENTAL, PLLC

LAKE HARBOR DENTAL, PLLC

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Company Details

Name: LAKE HARBOR DENTAL, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 04 Feb 2014 (12 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 409248
Place of Formation: IDAHO
File Number: 409248
ZIP code: 83703
County: Ada County
Principal Address: 5355 W STATE ST BOISE, ID 83703
Mailing Address: 5355 W STATE ST BOISE, ID 83703-3333

Agent

Name Role Address
ERIC BALLOU Agent 5355 W STATE ST, BOISE, ID 83703

Member

Name Role Address Appointed On Resigned On
MICHAEL PETERSON Member 5355 W STATE ST, BOISE, ID 83706 2021-03-04 2023-02-09
ERIC BALLOU Member 5355 W STATE ST, BOISE, ID 83702 2023-02-09 No data

National Provider Identifier

NPI Number:
1427669720
Certification Date:
2020-08-11
Link:
View on NPI website

Authorized Person:

Name:
ERIC BALLOU
Role:
OWNER
Phone:
2088534687

Taxonomy:

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

Contacts:

Phone:
+1 208-853-4687

Form 5500 Series

Employer Identification Number (EIN):
464776064
Plan Year:
2023
Number Of Participants:
16
Sponsors Telephone Number:
2088534687
File:
View File
Plan Year:
2022
Number Of Participants:
14
Sponsors Telephone Number:
2088534687
File:
View File
Plan Year:
2021
Number Of Participants:
12
Sponsors Telephone Number:
2088534687
File:
View File
Plan Year:
2020
Number Of Participants:
11
Sponsors Telephone Number:
2088534687
File:
View File
Plan Year:
2019
Number Of Participants:
12
Sponsors Telephone Number:
2088534687
File:
View File

Filing

Filing Name Filing Number Filing date
Annual Report 0006154581 2025-03-10
Annual Report 0005602931 2024-02-13
Annual Report 0005105438 2023-02-09
Annual Report 0004674548 2022-03-28
Annual Report 0004196365 2021-03-04

USAspending Awards / Financial Assistance

Date:
2020-05-16
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
150000.00
Total Face Value Of Loan:
150000.00
Date:
2020-04-09
Link:
View on USAspending
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:
143800.00
Total Face Value Of Loan:
143800.00

Paycheck Protection Program

Jobs Reported:
12
Initial Approval Amount:
$143,000
Date Approved:
2021-01-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$143,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
$144,030.38
Servicing Lender:
Washington Trust Bank
Use of Proceeds:
Payroll: $143,000
Jobs Reported:
13
Initial Approval Amount:
$143,800
Date Approved:
2020-04-09
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$143,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
$145,155.27
Servicing Lender:
Washington Trust Bank
Use of Proceeds:
Payroll: $143,800

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Related by address

5355 W STATE ST BOISE, ID 83703

LAKE HARBOR DENTAL PETERSON LAKE HARBOR PROPERTIES LLC IDAHO RECOVERY OUTREACH, INC.

5355 W STATE ST BOISE, ID 83703-3333

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Date of last update: 07 Aug 2025

Sources: Idaho Secretary of State

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