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IDENTISTRY PLLC

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Company Details

Name: IDENTISTRY PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 16 Dec 2020 (5 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 4101758
Place of Formation: IDAHO
File Number: 738061
ZIP code: 83628
County: Owyhee County
Principal Address: DR JARED MARTIN 115 S MAIN ST HOMEDALE, ID 83628
Mailing Address: 115 S MAIN ST HOMEDALE, ID 83628-3415

Agent

Name Role Address
Jared M Martin Agent 115 S MAIN ST, HOMEDALE, ID 83628

Manager

Name Role Address Appointed On
Jared M Martin Manager 115 S MAIN ST, HOMEDALE, ID 83628 2021-12-07

National Provider Identifier

NPI Number:
1477144038
Certification Date:
2021-01-27

Authorized Person:

Name:
DR. JARED M MARTIN
Role:
CEO
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005966555 2024-11-05
Annual Report 0005477223 2023-11-13
Annual Report 0005075872 2023-01-19
Annual Report 0004521383 2021-12-07
Initial Filing 0004101758 2020-12-16

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Date of last update: 08 Jul 2025

Sources: Idaho Secretary of State