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HIDDEN CREEK DENTAL, PLLC

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Company Details

Name: HIDDEN CREEK DENTAL, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 05 Dec 2024 (8 months ago)
Financial Date End: 31 Dec 2025
Entity Number: 6008738
Place of Formation: IDAHO
File Number: 966759
ZIP code: 83706
County: Ada County
Mailing Address: 580 W PARKCENTER BLVD BOISE, ID 83706-3659
Principal Address: 580 W. PARKCENTER BLVD. BOISE, ID 83706

Agent

Name Role Address
RYAN CLARK Agent 580 W. PARKCENTER BLVD., BOISE, ID 83706

National Provider Identifier

NPI Number:
1396554762
Certification Date:
2024-12-31

Authorized Person:

Name:
DR. RYAN JAMES CLARK
Role:
SOLE OWNER/DENTIST
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Amendment to Certificate 0006129131 2025-02-26
Change of Registered Office/Agent/Both (by Entity) 0006129120 2025-02-26
Statement of Change of Business Mailing Address 0006022106 2024-12-12
Initial Filing 0006008738 2024-12-05

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Date of last update: 12 Jul 2025

Sources: Idaho Secretary of State