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Chubbuck Kidz Dental, P.C.

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Company Details

Name: Chubbuck Kidz Dental, P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 02 Aug 2023 (2 years ago)
Financial Date End: 31 Aug 2026
Entity Number: 5338066
Place of Formation: IDAHO
File Number: 891536
ZIP code: 83202
County: Bannock County
Mailing Address: SUITE 300 371 E CHUBBUCK ROAD CHUBBUCK, ID 83202-9034

Director

Name Role Address Appointed On
Devin Belnap Director 4643 S ULSTER ST, DENVER, CO 80237 2024-08-29

President

Name Role Address Appointed On
Devin Belnap President 4643 S ULSTER ST, DENVER, CO 80237 2024-08-29

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 10020 W FAIRVIEW AVE, STE 104, BOISE, ID 83704

National Provider Identifier

NPI Number:
1801679287
Certification Date:
2023-08-18

Authorized Person:

Name:
MAGDALENA EVANS
Role:
SR. CREDENTIALING SPECIALIST
Phone:

Taxonomy:

Selected Taxonomy:
1223P0221X - Pediatric Dentist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006395177 2025-08-08
Registered Agent Name/Address Change (mass change) 0006279477 2025-05-27
Annual Report 0005874059 2024-08-29
Initial Filing 0005338066 2023-08-02

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Date of last update: 22 Aug 2025

Sources: Idaho Secretary of State