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Black Bear Dental PLLC

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Company Details

Name: Black Bear Dental PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 11 Jul 2024 (a year ago)
Financial Date End: 31 Jul 2026
Entity Number: 5817708
Place of Formation: IDAHO
File Number: 945595
ZIP code: 83706
County: Ada County
Principal Address: STE 140 600 E RIVERPARK LN BOISE, ID 83706
Mailing Address: STE 140 600 E RIVERPARK LN BOISE, ID 83706-6509

Agent

Name Role Address
Mary Krajicek Agent 600 E RIVERPARK LN, STE 140, BOISE, ID 83706

Member

Name Role Address Appointed On
Mary Krajicek Member 600 E RIVERPARK LN, BOISE, ID 83706 2025-06-04

National Provider Identifier

NPI Number:
1710719216
Certification Date:
2024-08-14

Authorized Person:

Name:
MARY KRAJICEK
Role:
DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
2089063862

Filing

Filing Name Filing Number Filing date
Annual Report 0006298116 2025-06-04
Initial Filing 0005817708 2024-07-11

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Date of last update: 21 Jun 2025

Sources: Idaho Secretary of State