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Fairview Dental, PLLC

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Company Details

Name: Fairview Dental, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 30 Mar 2023 (2 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 5171395
Place of Formation: IDAHO
File Number: 871562
ZIP code: 83651
County: Canyon County
Principal Address: 624 3RD ST. SOUTH NAMPA, ID 83651
Mailing Address: 624 3RD ST S NAMPA, ID 83651-3840

Agent

Name Role Address
Kim B. Keller Agent 624 3RD ST SOUTH, NAMPA, ID 83651

Manager

Name Role Address Appointed On
Kim B. Keller Manager 624 3RD ST. SOUTH, NAMPA, ID 83651 2024-03-08

National Provider Identifier

NPI Number:
1992480404
Certification Date:
2023-06-21

Authorized Person:

Name:
SEAN WASDEN
Role:
COO
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006095962 2025-02-04
Annual Report 0005641040 2024-03-08
Initial Filing 0005171395 2023-03-30

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Date of last update: 10 Jul 2025

Sources: Idaho Secretary of State