JOSEPH MOSS, DDS & TYLER TEBAY, DMD, P.S.

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Company Details

Legal Name:	JOSEPH MOSS, DDS & TYLER TEBAY, DMD, P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	March 9th 1998
Expiration date:	31 Mar 2026
UBI Number:	601 859 352
ZIP code:	98506
City:	Olympia
County:	THURSTON
Home State:	WASHINGTON
Principal Office Street Address:	1105 4TH AVE E STE A, OLYMPIA, WA, 98506-4018, UNITED STATES

Contact Details

E-Mail:	ADMIN@OLYMPIAADVANCEDDENTISTRY.COM
Phone Number:	+1 360-357-8075

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
BEAN, GENTRY, WHEELER & PETERNELL, PLLC	Registered Agent	910 LAKERIDGE WAY SW, OLYMPIA, WA, 98502-6036, UNITED STATES

Key Officers & Management

Name	Role	Address
JOSEPH MOSS	Governing Person	1105 4TH AVE E, SUITE A, OLYMPIA, WA, 98506, UNITED STATES
TYLER TEBAY	Governing Person	-

National Provider Identifier

NPI Number:

1912167248

Certification Date:

2023-07-31

Link:

View on NPI website

Authorized Person:

Name:

DAWN QUESADA

Role:

OFFICE MANAGER/ADMINISTRATOR

Phone:

3603578075

Taxonomy:

Selected Taxonomy:

1223G0001X - General Practice Dentistry

Is Primary:

Yes

Contacts:

Phone:

+1 360-357-8075

Fax:

3603573842

Form 5500 Series

Employer Identification Number (EIN):

911890325

Plan Year:

2018

Number Of Participants:

26

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3603578075

File:

Plan Year:

2017

Number Of Participants:

23

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3603578075

File:

Plan Year:

2016

Number Of Participants:

20

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3603578075

File:

Plan Administrator / Signatory:

CAROL J. COOPER(Plan administrator)

Plan Year:

2015

Number Of Participants:

0

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3603578075

File:

Plan Administrator / Signatory:

BRUCE E. COOPER(Plan administrator)

History

Type	Old value	New value	Date of change
Name change	COOPER MOSS ADVANCED DENTISTRY, P.S.	JOSEPH MOSS, DDS & TYLER TEBAY, DMD, P.S.	2020-07-16

Paycheck Protection Program

Jobs Reported:

19

Initial Approval Amount:

$264,721

Date Approved:

2021-02-19

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$264,721

Race:

White

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$266,699.05

Servicing Lender:

TwinStar Credit Union

Use of Proceeds:

Payroll: $264,721

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