Search icon

Table Rock Oral Surgery PLLC

Company claim

Is this your business?

Get access!

Company Details

Name: Table Rock Oral Surgery PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 May 2021 (4 years ago)
Financial Date End: 31 May 2026
Entity Number: 4261215
Place of Formation: IDAHO
File Number: 761456
ZIP code: 83702
County: Ada County
Principal Address: STE 320 403 S 11TH STREET BOISE, ID 83702
Mailing Address: STE 320 403 S 11TH ST BOISE, ID 83702-6968

Agent

Name Role Address
Timothy OBrien Agent 403 S 11TH ST, # 320, BOISE, ID 83702

Member

Name Role Address Appointed On
Timothy OBrien Member 5350 E SOFTWOOD CT, BOISE, ID 83716 2022-05-04

Manager

Name Role Address Appointed On
Timothy OBrien Manager 5350 E SOFTWOOD CT, BOISE, ID 83716 2024-04-22

National Provider Identifier

NPI Number:
1487238689
Certification Date:
2024-04-10

Authorized Person:

Name:
TIMOTHY OBRIEN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QS0112X - Oral and Maxillofacial Surgery Clinic/Center
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
863622119
Plan Year:
2023
Number Of Participants:
9
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006229169 2025-05-03
Annual Report 0005699970 2024-04-22
Application for Reinstatement 0005351582 2023-08-04
Dissolution/Revocation - Administrative 0005349590 2023-08-04
Annual Report 0004733059 2022-05-04

Reviews Leave a review

This company hasn't received any reviews.

Date of last update: 08 Jul 2025

Sources: Idaho Secretary of State