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Club 32 Dental Caldwell, PLLC

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Company Details

Name: Club 32 Dental Caldwell, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 22 Mar 2021 (4 years ago)
Financial Date End: 31 Mar 2025
Date dissolved: 07 Mar 2025
Entity Number: 4215520
Place of Formation: IDAHO
File Number: 754122
ZIP code: 83605
County: Canyon County
Principal Address: 1916 ELLIS AVE CALDWELL, ID 83605
Mailing Address: DR. KIM KELLER 624 3RD ST S NAMPA, ID 83651-3840

Agent

Name Role Address
KIM B KELLER Agent 450 W ISLAND CT, NAMPA, ID 83686

Member

Name Role Address Appointed On
Kim Keller Member 450 W ISLAND CT, NAMPA, ID 83686 2022-04-25

National Provider Identifier

NPI Number:
1033796305
Certification Date:
2022-03-10

Authorized Person:

Name:
DR. KIM KELLER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0006145199 2025-03-06
Annual Report 0005592428 2024-02-08
Annual Report 0005090304 2023-02-03
Annual Report 0004714532 2022-04-25
Initial Filing 0004215520 2021-03-22

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Date of last update: 16 Apr 2025

Sources: Idaho Secretary of State