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BLACK CANYON DENTAL, PC

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Company Details

Name: BLACK CANYON DENTAL, PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 17 May 2004 (21 years ago)
Financial Date End: 31 May 2012
Date dissolved: 07 Aug 2012
Entity Number: 470222
Place of Formation: IDAHO
File Number: 0000470222
ZIP code: 83617
County: Gem County
Mailing Address: 1110 S WASHINGTON AVE EMMETT, ID 83617

National Provider Identifier

NPI Number:
1679732804

Authorized Person:

Name:
MR. SHON D ROOKS
Role:
PRESIDENT
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0002972210 2011-04-25
Annual Report 0002972209 2010-04-27
Annual Report 0002972208 2009-06-09
Annual Report 0002972212 2008-03-12
Annual Report 0002972211 2007-03-09

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State