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  5. LAKE CITY DENTAL SPECIALTIES, PLLC

LAKE CITY DENTAL SPECIALTIES, PLLC

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Company Details

Name: LAKE CITY DENTAL SPECIALTIES, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 18 May 2012 (13 years ago)
Financial Date End: 31 May 2026
Entity Number: 587781
Place of Formation: IDAHO
File Number: 587781
ZIP code: 83815
County: Kootenai County
Principal Address: STE 2 1332 W KATHLEEN AVE COEUR D ALENE, ID 83815
Mailing Address: 2208 N MERRITT CREEK LOOP COEUR D ALENE, ID 83814-4959

Agent

Name Role Address
SHAUN M WHITNEY DDS Agent 2208 NORTH MERRITT CREEK LOOP, COEUR D ALENE, ID 83814

Governor

Name Role Address Appointed On Resigned On
SHAUN M. WHITNEY, D.D.S. Governor 1332 WEST KATHLEEN AVENUE, COEUR D ALENE, ID 83815 2023-03-15 2023-05-09

President

Name Role Address Appointed On Resigned On
SHAUN MICHAEL WHITNEY President 1322 KATHLEEN AVE. SUITE 2, COEUR D ALENE, ID 83815 2021-04-07 2022-06-02

Member

Name Role Address Appointed On
SHAUN M. WHITNEY, D.D.S. Member 1332 WEST KATHLEEN AVENUE, COEUR D ALENE, ID 83815 2023-05-09
Shaun M Whitney DDS Member 2208 NORTH MERRITT CREEK LOOP, COEUR D ALENE, ID 83814 2025-04-03

National Provider Identifier

NPI Number:
1356693915
Link:
View on NPI website

Authorized Person:

Name:
DR. SHAUN MICHAEL WHITNEY
Role:
PRESIDENT
Phone:
2086647300

Taxonomy:

Selected Taxonomy:
1223E0200X - Endodontist
Is Primary:
No
Selected Taxonomy:
1223P0300X - Periodontist
Is Primary:
Yes

Contacts:

Phone:
+1 208-664-7300
Fax:
2086647333

Form 5500 Series

Employer Identification Number (EIN):
455351687
Plan Year:
2023
Number Of Participants:
5
Sponsors Telephone Number:
2086647300
File:
View File
Plan Year:
2022
Number Of Participants:
5
Sponsors Telephone Number:
2086647300
File:
View File
Plan Year:
2021
Number Of Participants:
6
Sponsors Telephone Number:
2086647300
File:
View File
Plan Year:
2020
Number Of Participants:
6
Sponsors Telephone Number:
2086647300
File:
View File
Plan Year:
2019
Number Of Participants:
5
Sponsors Telephone Number:
2086647300
File:
View File

Filing

Filing Name Filing Number Filing date
Statement of Change of Business Mailing Address 0006183790 2025-04-03
Annual Report 0006183821 2025-04-03
Annual Report 0005672371 2024-04-04
Annual Report 0005233988 2023-05-09
Statement of Conversion 0005157190 2023-03-15

USAspending Awards / Financial Assistance

Date:
2021-01-27
Link:
View on USAspending
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:
61400.00
Total Face Value Of Loan:
61400.00
Date:
2020-04-28
Link:
View on USAspending
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:
80000.00
Total Face Value Of Loan:
80000.00
Date:
2020-04-27
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
7000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2014-05-19
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
50000.00
Total Face Value Of Loan:
50000.00
Date:
2012-06-14
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
475000.00
Total Face Value Of Loan:
475000.00

Paycheck Protection Program

Jobs Reported:
7
Initial Approval Amount:
$80,000
Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$80,000
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$80,396.86
Servicing Lender:
bankcda
Use of Proceeds:
Payroll: $80,000
Jobs Reported:
7
Initial Approval Amount:
$61,400
Date Approved:
2021-01-27
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$61,400
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$61,816.16
Servicing Lender:
bankcda
Use of Proceeds:
Payroll: $61,395
Utilities: $1

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Date of last update: 04 Jul 2025

Sources: Idaho Secretary of State

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