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Clearwater Dental PLLC

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Company Details

Name: Clearwater Dental PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 01 May 2023 (2 years ago)
Financial Date End: 31 May 2026
Entity Number: 5215769
Place of Formation: IDAHO
File Number: 876980
ZIP code: 83651
County: Canyon County
Principal Address: KIM B. KELLER 624 3RD ST S NAMPA, ID 83651-3840
Mailing Address: KIM B, KELLER 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 Keller Manager 624 3RD ST S, NAMPA, ID 83651 2025-05-04

National Provider Identifier

NPI Number:
1215628268
Certification Date:
2023-05-18

Authorized Person:

Name:
SEAN WASDEN
Role:
COO
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006232352 2025-05-04
Application for Reinstatement 0005859837 2024-08-13
Dissolution/Revocation - Administrative 0005857856 2024-08-13
Change of Registered Office/Agent/Both (by Entity) 0005220547 2023-05-03
Initial Filing 0005215769 2023-05-01

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Date of last update: 10 Jul 2025

Sources: Idaho Secretary of State