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Innovative Sleep & TMJ Center, PLLC

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Company Details

Name: Innovative Sleep & TMJ Center, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 Nov 2023 (2 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 5454677
Place of Formation: IDAHO
File Number: 905655
ZIP code: 83646
County: Ada County
Principal Address: DR RANDALL SMITH 1720 W MCMILLAN RD MERIDIAN, ID 83646
Mailing Address: DR RANDALL SMITH 1720 W MCMILLAN RD MERIDIAN, ID 83646-6892

Agent

Name Role Address
Randall B Smith Agent 5113 N GOLDEN VIEW CT, STAR, ID 83669

Manager

Name Role Address Appointed On
Randall Smith Manager 5113 N GOLDEN VIEW CT, STAR, ID 83669 2024-10-14

National Provider Identifier

NPI Number:
1124892773
Certification Date:
2024-11-21

Authorized Person:

Name:
DR. RANDALL B SMITH
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
332BC3200X - Customized Equipment (DME)
Is Primary:
No
Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005941485 2024-10-14
Initial Filing 0005454677 2023-11-02

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Date of last update: 21 May 2025

Sources: Idaho Secretary of State