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PALOUSE ORAL & MAXILLOFACIAL SURGERY

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Company Details

Name: PALOUSE ORAL & MAXILLOFACIAL SURGERY
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 24 Jun 1998 (27 years ago)
Entity Number: 62609
Place of Formation: IDAHO
File Number: 0000062609
ZIP code: 83843
County: Latah County
Mailing Address: 1414 S MAIN ST MOSCOW, ID 83843

National Provider Identifier

NPI Number:
1497083638

Authorized Person:

Name:
DR. JOHN WALLACE MORRISN
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
820513254
Plan Year:
2009
Number Of Participants:
9
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0000674643 1999-07-06
Initial Filing 0000062609 1998-06-24

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State