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PETER W. JACOBSEN, D.D.S., PLLC

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Company Details

Legal Name: PETER W. JACOBSEN, D.D.S., PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: October 20th 2008
Date of Dissolution: February 1st 2016
Expiration date: 31 Oct 2015
UBI Number: 602 872 749
ZIP code: 98038
City: Maple Valley
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 27016 MAPLE VALLEY, BLACK DIAMOND RD SE, MAPLE VALLEY, WA, 98038, UNITED STATES

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Registered Agent Information

Name Role Address
RONALD ALLEN Registered Agent 601 UNION ST #4950, SEATTLE, WA, 98101, UNITED STATES

Key Officers & Management

Name Role Address
PETER JACOBSEN Governing Person 27081 185TH AVE SE B-105, COVINGTON, WA, 98042, UNITED STATES

National Provider Identifier

NPI Number:
1053480988

Authorized Person:

Name:
JULIE S CIELO
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
4254138599

Form 5500 Series

Employer Identification Number (EIN):
912182383
Plan Year:
2012
Number Of Participants:
150
Sponsor's telephone number:
Plan Administrator / Signatory:
JULIE HAWKEN(Plan administrator)

OSHA's Inspections within Industry

Inspection Summary

Date:
2011-12-07
Type:
Planned
Address:
27016 MAPLE VALLEY BLK DIA SE, MAPLE VALLEY, WA, 98038
Safety Health:
Health
Scope:
Complete
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