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Spartan Dental Company, PLLC

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Company Details

Name: Spartan Dental Company, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 13 Dec 2024 (6 months ago)
Financial Date End: 31 Dec 2025
Entity Number: 6024987
Place of Formation: IDAHO
File Number: 967893
ZIP code: 83716
County: Elmore County
Principal Address: THOMAS CHRISTY 7916 SOUTH BOGUS RIDGE WAY BOISE, ID 83716
Mailing Address: THOMAS CHRISTY 7916 S BOGUS RIDGE WAY BOISE, ID 83716-3416

Agent

Name Role Address
Thomas Christy Agent 7916 SOUTH BOGUS RIDGE WAY, BOISE, ID 83716

National Provider Identifier

NPI Number:
1932910114
Certification Date:
2025-01-16

Authorized Person:

Name:
DAVID ROBERT BORGHOLTHAUS
Role:
MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2085871906

Filing

Filing Name Filing Number Filing date
Initial Filing 0006024987 2024-12-13

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Date of last update: 23 May 2025

Sources: Idaho Secretary of State