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Modern Smiles Pocatello PC

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Company Details

Name: Modern Smiles Pocatello PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 08 Aug 2022 (3 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 4851828
Place of Formation: IDAHO
File Number: 835033
ZIP code: 83642
County: Ada County
Mailing Address: 3732 W DAISY CREEK ST MERIDIAN, ID 83642-7968

Agent

Name Role Address
Chris A Satchwell Agent 3732 W DAISY CREEK STREET, MERIDAIN, ID 83642

Secretary

Name Role Address Appointed On
April Satchwell Secretary 3732 W DIASY CREEK ST, MERIDAIN, ID 83642 2023-07-04

Director

Name Role Address Appointed On
Chris A Satchwell Director 3732 W DIASY CREEK ST, MERIDAIN, ID 83642 2023-07-04

National Provider Identifier

NPI Number:
1609592435
Certification Date:
2023-02-10

Authorized Person:

Name:
STEPHANIE FRANK
Role:
CREDENTIALING COORDINATOR
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005894296 2024-09-09
Annual Report 0005302361 2023-07-04
Initial Filing 0004851828 2022-08-08

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Date of last update: 18 Jun 2025

Sources: Idaho Secretary of State