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FACIAL ORAL AND DENTAL IMPLANT SURGERY ASSOCIATES P.C.

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Company Details

Name: FACIAL ORAL AND DENTAL IMPLANT SURGERY ASSOCIATES P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 23 Jan 2017 (9 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 630180
Place of Formation: IDAHO
File Number: 630180
ZIP code: 83501
County: Nez Perce County
Mailing Address: 444 THAIN RD LEWISTON, ID 83501-5339

Agent

Name Role Address
STEPHEN W HOLM Agent 444 THAIN RD, LEWISTON, ID 83501

Director

Name Role Address Appointed On Resigned On
Sherdon Cordova Director 444 THAIN ROAD, LEWISTON, ID 83501 2023-12-11 2023-12-11
Stephen Holm Director 444 THAIN ROAD, LEWISTON, ID 83501 2021-01-04 No data

National Provider Identifier

NPI Number:
1003060591

Authorized Person:

Name:
DR. STEPHEN WILFORD HOLM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary:
Yes

Contacts:

Fax:
2087431643

Form 5500 Series

Employer Identification Number (EIN):
270616863
Plan Year:
2022
Number Of Participants:
27
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
23
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
17
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
17
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
13
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006016752 2024-12-08
Annual Report 0005508335 2023-12-11
Annual Report 0005008645 2022-12-03
Annual Report 0004515881 2021-12-03
Annual Report 0004117660 2021-01-04

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Date of last update: 15 Aug 2025

Sources: Idaho Secretary of State