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STACY J. MOON, D.D.S., P.A.

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Company Details

Name: STACY J. MOON, D.D.S., P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved
Date of registration: 20 Dec 2000 (25 years ago)
Financial Date End: 31 Dec 2024
Date dissolved: 12 Oct 2024
Entity Number: 417425
Place of Formation: IDAHO
File Number: 417425
ZIP code: 83714
County: Ada County
Mailing Address: 3550 N BROOKSIDE LN BOISE, ID 83714-9705

Agent

Name Role Address
STACY J MOON Agent 3550 N. BROOKSIDE LANE, BOISE, ID 83714

President

Name Role Address Appointed On
Stacy J. Moon DDS, PA President 3550 N. BROOKSIDE LANE, BOISE, ID 83714-0000 2020-12-03

Secretary

Name Role Address Appointed On
Susan Moon Secretary 3550 N. BROOKSIDE LANE, BOISE, ID 83714-0000 2023-11-07

National Provider Identifier

NPI Number:
1851554737

Authorized Person:

Name:
DR. STACY JERALD MOON
Role:
PRESIDENT
Phone:

Taxonomy:

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

Contacts:

Fax:
2089386032

Filing

Filing Name Filing Number Filing date
Articles of Dissolution 0005940311 2024-10-12
Annual Report 0005470254 2023-11-07
Annual Report Amendment 0005042606 2022-12-30
Annual Report Amendment 0005042539 2022-12-30
Annual Report Amendment 0005042608 2022-12-30

USAspending Awards / Financial Assistance

Date:
2020-05-29
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:
2020-04-28
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:
105408.08
Total Face Value Of Loan:
105408.08
Date:
2010-06-03
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO ASSIST SMALL BUSINESS CONCERNS BY PROVIDING LONG TERM FINANCING THROUGH THE SALE OF DEBENTURES TO THE PRIVATE SECTOR
Obligated Amount:
0.00
Face Value Of Loan:
332000.00
Total Face Value Of Loan:
332000.00

Paycheck Protection Program

Jobs Reported:
14
Initial Approval Amount:
$105,408.08
Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$105,408.08
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$106,234.02
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $105,408.08
Jobs Reported:
13
Initial Approval Amount:
$105,407
Date Approved:
2021-01-25
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$105,407
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$105,978.8
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $105,403
Utilities: $1

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Date of last update: 21 Jul 2025

Sources: Idaho Secretary of State