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Dan R. Wilson DDS P.C.

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Company Details

Name: Dan R. Wilson DDS P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 15 Apr 2024 (a year ago)
Financial Date End: 30 Apr 2026
Entity Number: 5692860
Place of Formation: IDAHO
File Number: 931818
ZIP code: 83501
County: Nez Perce County
Mailing Address: DR. DAN WILSON 638 BRYDEN AVE LEWISTON, ID 83501-5169

Agent

Name Role Address
Adriatik Rama Agent 638 BRYDEN AVENUE, LEWISTON, ID 83501

National Provider Identifier

NPI Number:
1578304432
Certification Date:
2024-06-04

Authorized Person:

Name:
MERCEDES FIGUEROA
Role:
CREDENTIALING SPECIALIST
Phone:

Taxonomy:

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

Contacts:

Fax:
6232892015

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0006367456 2025-07-22
Dissolution/Revocation - Administrative 0006364567 2025-07-18
Initial Filing 0005692860 2024-04-15

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Date of last update: 26 Jul 2025

Sources: Idaho Secretary of State