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WAYNE MORTENSEN DMD, P.C.

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Company Details

Name: WAYNE MORTENSEN DMD, P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 28 Dec 2010 (15 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 572537
Place of Formation: IDAHO
File Number: 572537
ZIP code: 83714
County: Ada County
Mailing Address: 9213 W STATE ST BOISE, ID 83714-1737

Agent

Name Role Address
WAYNE MORTENSEN Agent 9213 W STATE ST, BOISE, ID 83714

President

Name Role Address Appointed On
Wayne A Mortensen President 9213 W STATE STREET, BOISE, ID 83714 2020-11-03

National Provider Identifier

NPI Number:
1134885684
Certification Date:
2023-07-06

Authorized Person:

Name:
WAYNE MORTENSEN
Role:
DR/OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
2082583282

Form 5500 Series

Employer Identification Number (EIN):
274497919
Plan Year:
2023
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
9
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
13
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005989662 2024-11-20
Annual Report 0005483111 2023-11-17
Annual Report 0005010617 2022-12-05
Annual Report 0004524345 2021-12-10
Annual Report 0004048766 2020-11-03

USAspending Awards / Financial Assistance

Date:
2021-03-20
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
49515.00
Total Face Value Of Loan:
49515.00

Paycheck Protection Program

Jobs Reported:
8
Initial Approval Amount:
$49,515
Date Approved:
2021-03-20
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$49,515
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$49,945.03
Servicing Lender:
KeyBank National Association
Use of Proceeds:
Payroll: $49,515

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Date of last update: 04 Jul 2025

Sources: Idaho Secretary of State