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TREASURE VALLEY PERIODONTICS

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Company Details

Name: TREASURE VALLEY PERIODONTICS
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 01 Feb 2016 (9 years ago)
Entity Number: 556643
Place of Formation: IDAHO
File Number: 0000556643
ZIP code: 83703
County: Ada County
Mailing Address: 813 N STILSON RD STE C BOISE, ID 83703

National Provider Identifier

NPI Number:
1972968998

Authorized Person:

Name:
DR. KATHLEEN A BEAUDRY
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223P0300X - Periodontist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000556643 2016-02-01

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State