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ID OMS Specialty Dental Services, PLLC

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Company Details

Name: ID OMS Specialty Dental Services, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 16 Aug 2021 (4 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 4385569
Place of Formation: IDAHO
File Number: 777508
ZIP code: 83642
County: Ada County
Principal Address: SPECIALTY DENTAL BRANDS GENERAL COUNSEL 1200 CHERRY LANE MERIDIAN, ID 83642
Mailing Address: LEGAL STE 205 1610 54TH AVE N NASHVILLE, TN 37209-1442

Agent

Name Role Address
REGISTERED AGENT SOLUTIONS, INC. Agent 1555 W SHORELINE DR, STE 100, BOISE, ID 83702

Member

Name Role Address Appointed On
Kevin Chad Lambourne Member 1610 54TH AVENUE N, NASHVILLE, TN 37209 2022-08-08

National Provider Identifier

NPI Number:
1467218552
Certification Date:
2024-02-26

Authorized Person:

Name:
CHARLOTTE DASCH
Role:
DIRECTOR OF CREDENTIALING AND PR
Phone:

Taxonomy:

Selected Taxonomy:
1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005798500 2024-07-03
Annual Report 0005306680 2023-07-06
Registered Agent Name/Address Change (mass change) 0004909094 2022-09-12
Annual Report 0004851838 2022-08-08
Initial Filing 0004385569 2021-08-16

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Date of last update: 20 May 2025

Sources: Idaho Secretary of State