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Town Square Dental-Burley, PLLC

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Company Details

Name: Town Square Dental-Burley, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 21 May 2024 (a year ago)
Financial Date End: 31 May 2026
Entity Number: 5744267
Place of Formation: IDAHO
File Number: 938082
ZIP code: 83350
County: Minidoka County
Principal Address: 502 8TH STREET RUPERT, ID 83350
Mailing Address: 502 8TH ST RUPERT, ID 83350-1417

Agent

Name Role Address
Nathan Catmull Agent 502 8TH STREET, RUPERT, ID 83350

Member

Name Role Address Appointed On
Nathan Catmull Member 502 8TH STREET, RUPERT, ID 83350 2025-04-04

National Provider Identifier

NPI Number:
1992547442
Certification Date:
2024-06-11

Authorized Person:

Name:
YURI ARTEAGA
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
8668824187

Filing

Filing Name Filing Number Filing date
Annual Report 0006189195 2025-04-04
Initial Filing 0005744267 2024-05-21

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Date of last update: 22 May 2025

Sources: Idaho Secretary of State