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PERIODONTAL HEALTH SPECIALISTS OF IDAHO

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Company Details

Name: PERIODONTAL HEALTH SPECIALISTS OF IDAHO
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 31 Jul 2014 (11 years ago)
Entity Number: 523603
Place of Formation: IDAHO
File Number: 0000523603
Mailing Address: 140 E BOISE AVE BOISE, ID 83706-4373

National Provider Identifier

NPI Number:
1689077026
Certification Date:
2023-05-08

Authorized Person:

Name:
RANDY S DEMETTER
Role:
OWNER/PARTNER
Phone:

Taxonomy:

Selected Taxonomy:
1223P0300X - Periodontist
Is Primary:
Yes

Contacts:

Fax:
2083859292

Form 5500 Series

Employer Identification Number (EIN):
471378590
Plan Year:
2022
Number Of Participants:
26
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
25
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
24
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
23
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0003628255 2019-09-25
Amendment of Certificate of Assumed Business Name 0003591248 2019-08-08
Amendment of Mailing Address for Certificate of Assumed Business Name 0003591238 2019-08-08
Initial Filing 0000523603 2014-07-31

Paycheck Protection Program

Jobs Reported:
18
Initial Approval Amount:
$212,860
Date Approved:
2021-02-19
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$212,860
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$213,892.23
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $212,857
Utilities: $1
Jobs Reported:
20
Initial Approval Amount:
$193,800
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$193,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$195,276.07
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $145,350
Utilities: $24,225
Rent: $24,225

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State