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KELLY B. MANSFIELD D.D.S. P.C.

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Company Details

Name: KELLY B. MANSFIELD D.D.S. P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 02 May 2003 (22 years ago)
Financial Date End: 31 May 2026
Entity Number: 453419
Place of Formation: IDAHO
File Number: 453419
ZIP code: 83686
County: Canyon County
Mailing Address: 109 12TH AVE RD NAMPA, ID 83686-5047

Agent

Name Role Address
KELLY B MANSFIELD Agent 109 12TH AVE RD, NAMPA, ID 83686

President

Name Role Address Appointed On Resigned On
Kelly B Mansfield President 12130 RIVENDELL CT, NAMPA, ID 83686 2021-02-22 2022-09-20
Kelly B. Mansfield President 109 12TH AVE RD, NAMPA, ID 83686-5047 2022-09-20 No data

Secretary

Name Role Address Appointed On Resigned On
Sheryl Mansfield Secretary 109 12TH AVE RD, NAMPA, ID 83686-5047 2024-06-05 2024-06-05

National Provider Identifier

NPI Number:
1487813937

Authorized Person:

Name:
DR. KELLY B MANSFIELD
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
331055252
Plan Year:
2023
Number Of Participants:
22
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
23
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
22
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
23
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
22
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006291893 2025-06-02
Annual Report 0005762778 2024-06-05
Annual Report 0005264675 2023-06-04
Application for Reinstatement 0004920893 2022-09-20
Dissolution/Revocation - Administrative 0004859267 2022-08-12

Paycheck Protection Program

Jobs Reported:
12
Initial Approval Amount:
$125,000
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$125,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$126,308.22
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $125,000

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Date of last update: 22 Jul 2025

Sources: Idaho Secretary of State