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BAKER PEDIATRIC DENTISTRY PLLC

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Company Details

Name: BAKER PEDIATRIC DENTISTRY PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 21 Sep 2016 (9 years ago)
Financial Date End: 30 Sep 2025
Date dissolved: 08 Dec 2022
Entity Number: 520656
Place of Formation: IDAHO
File Number: 520656
ZIP code: 83401
County: Bonneville County
Mailing Address: 1900 JOHN ADAMS PKWY IDAHO FALLS, ID 83401-4366

Agent

Name Role Address
Thomas C Baker Agent 1900 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401

Manager

Name Role Address Appointed On
Thomas C Baker Manager 1900 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401 2021-01-30

National Provider Identifier

NPI Number:
1407211725
Certification Date:
2020-06-18

Authorized Person:

Name:
THOMAS CECIL BAKER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
No
Selected Taxonomy:
1223P0221X - Pediatric Dentist
Is Primary:
Yes

Contacts:

Fax:
2085246100

Form 5500 Series

Employer Identification Number (EIN):
475550868
Plan Year:
2023
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
5
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0006076468 2025-01-21
Dissolution/Revocation - Administrative 0005019253 2022-12-08
Annual Report 0004495187 2021-11-10
Application for Reinstatement 0004148301 2021-01-30
Dissolution/Revocation - Administrative 0004092510 2020-12-08

Paycheck Protection Program

Jobs Reported:
10
Initial Approval Amount:
$87,000
Date Approved:
2020-04-06
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$87,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$87,638.79
Servicing Lender:
The Bank of Commerce
Use of Proceeds:
Payroll: $87,000

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Date of last update: 03 Jul 2025

Sources: Idaho Secretary of State