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Idaho Family Dental Center, PLLC

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Company Details

Name: Idaho Family Dental Center, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 29 Mar 2022 (3 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 4675631
Place of Formation: IDAHO
File Number: 814081
ZIP code: 83815
County: Kootenai County
Principal Address: 201 509 W HANLEY AVE COEUR D ALENE, ID 83815
Mailing Address: STE 201 509 W HANLEY AVE COEUR D ALENE, ID 83815-8994

Agent

Name Role Address
Jordan Zingerman Agent 509 W HANLEY AVE, 201, COEUR D ALENE, ID 83815

Manager

Name Role Address Appointed On Resigned On
Matthew Nordlie, DMD Manager 509 W HANLEY AVE, COEUR D ALENE, ID 83815 2024-02-06 2024-02-06
Jordan Zingerman, DMD Manager 509 W HANLEY AVE, COEUR D ALENE, ID 83815 2022-06-22 No data

National Provider Identifier

NPI Number:
1811625700
Certification Date:
2022-08-04

Authorized Person:

Name:
DR. MATTHEW DAVID NORDLIE
Role:
OWNER/DENTIST
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006089405 2025-02-03
Annual Report 0005588945 2024-02-06
Annual Report 0005129325 2023-03-01
Change of Registered Office/Agent/Both (by Entity) 0004789016 2022-06-22
Amendment to Certificate 0004789009 2022-06-22

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Date of last update: 09 Jul 2025

Sources: Idaho Secretary of State