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INTERMOUNTAIN DENTAL SPECIALISTS, PLLC

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Company Details

Name: INTERMOUNTAIN DENTAL SPECIALISTS, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 28 Feb 2014 (11 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 412136
Place of Formation: IDAHO
File Number: 412136
ZIP code: 83616
County: Ada County
Principal Address: 4466 W PRICKLY PEAR DR EAGLE, ID 83616
Mailing Address: 12249 W MCMILLAN RD BOISE, ID 83713-0555

Agent

Name Role Address
JERRY CARBONE Agent 4466 W PRICKLY PEAR DR, EAGLE, ID 83616

Manager

Name Role Address Appointed On
Jerry M Carbone Manager 12249 W. MCMILLAN RD., BOISE, ID 83713 2021-01-17

National Provider Identifier

NPI Number:
1134522535

Authorized Person:

Name:
DR. JERRY MICHAEL CARBONE
Role:
MANAGING MEMBER
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006103942 2025-02-10
Annual Report 0005573050 2024-01-28
Annual Report 0005097574 2023-02-06
Annual Report 0004584997 2022-01-30
Annual Report 0004136996 2021-01-17

USAspending Awards / Financial Assistance

Date:
2020-07-24
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:
-68900.00
Total Face Value Of Loan:
0.00
Date:
2020-04-13
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
3000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-11
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:
36800.00
Total Face Value Of Loan:
36800.00

Paycheck Protection Program

Jobs Reported:
5
Initial Approval Amount:
$36,800
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$36,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$37,259.75
Servicing Lender:
KeyBank National Association
Use of Proceeds:
Payroll: $36,800

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Date of last update: 21 Jul 2025

Sources: Idaho Secretary of State