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Fellows Family Dental - AD, PLLC

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Company Details

Name: Fellows Family Dental - AD, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 21 Apr 2025 (3 months ago)
Financial Date End: 30 Apr 2026
Entity Number: 6213743
Place of Formation: IDAHO
File Number: 989824
ZIP code: 83201
County: Bannock County
Principal Address: STE B 1598 DELPHIC WAY POCATELLO, ID 83201
Mailing Address: STE B 1598 DELPHIC WAY POCATELLO, ID 83201-2200

Agent

Name Role Address
Richard Fellows Agent 1598 DELPHIC WAY, STE B, POCATELLO, ID 83201-2200

National Provider Identifier

NPI Number:
1164215372
Certification Date:
2025-05-28

Authorized Person:

Name:
MALINDA PARKER
Role:
OFFICE MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2082371418

Filing

Filing Name Filing Number Filing date
Initial Filing 0006213743 2025-04-21

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Date of last update: 22 Jun 2025

Sources: Idaho Secretary of State