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  5. IDAHO INNOVATIVE DENTISTRY, PLLC

IDAHO INNOVATIVE DENTISTRY, PLLC

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Company Details

Name: IDAHO INNOVATIVE DENTISTRY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 20 Apr 2015 (10 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 458182
Place of Formation: IDAHO
File Number: 458182
ZIP code: 83616
County: Ada County
Principal Address: 467 S RIVERSHORE LANE EAGLE, ID 83616
Mailing Address: 45 COTTONWOOD CT # 110 EAGLE, ID 83616-6577

Agent

Name Role Address
SHANE S PORTER, DMD Agent 45 W COTTONWOOD CT #110, EAGLE, ID 83616

Manager

Name Role Address Appointed On
Shane S Porter Manager 45 W COTTONWOOD CT #110, EAGLE, ID 83616 2021-03-03

National Provider Identifier

NPI Number:
1649620139
Link:
View on NPI website

Authorized Person:

Name:
DR. SHANE STEVEN PORTER
Role:
DENTIST/OWNER
Phone:
2089381247

Taxonomy:

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

Contacts:

Phone:
+1 208-938-1247

Filing

Filing Name Filing Number Filing date
Annual Report 0006248807 2025-05-12
Annual Report 0005668066 2024-04-03
Annual Report 0005233103 2023-05-08
Annual Report 0004631333 2022-03-03
Annual Report 0004192070 2021-03-03

USAspending Awards / Financial Assistance

Date:
2021-04-29
Link:
View on USAspending
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:
41578.00
Total Face Value Of Loan:
41578.00
Date:
2020-06-26
Link:
View on USAspending
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:
24900.00
Total Face Value Of Loan:
24900.00
Date:
2020-05-12
Link:
View on USAspending
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:
44500.00
Total Face Value Of Loan:
44500.00
Date:
2017-02-14
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
25000.00
Total Face Value Of Loan:
50000.00
Date:
2016-07-06
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
345000.00
Total Face Value Of Loan:
345000.00

Paycheck Protection Program

Date Approved:
2020-05-12
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
44500
Current Approval Amount:
44500
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
45020.59
Date Approved:
2021-04-29
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
41578
Current Approval Amount:
41578
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
41727.23

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45 COTTONWOOD CT # 110 EAGLE, ID 83616-6577

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Date of last update: 01 Jul 2025

Sources: Idaho Secretary of State

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