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  5. Northern Lights Dental Anesthesia, LLC

Northern Lights Dental Anesthesia, LLC

Contents

Company Details

Name: Northern Lights Dental Anesthesia, LLC
Jurisdiction: Alaska
Legal type: Limited Liability Company
Status: Good Standing
Date of registration: 04 Mar 2014 (11 years ago)
Entity Number: 10019178
ZIP code: 99515
County: Anchorage
Place of Formation: ALASKA
Address: 205 E DIMOND BLVD #200, ANCHORAGE, AK 99515

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621210 OFFICES OF DENTISTS

Officers

Name Role
Kenley Michaud Member
JOHN TIEMESSEN Registered Agent

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
KENLEY MICHAUD DDS, INC DEFINED BENEFIT PLAN & TRUST 2023 465023932 2024-02-27 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2024-02-27
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC 401(K) PLAN & TRUST 2023 465023932 2024-02-27 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2024-02-27
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC DEFINED BENEFIT PLAN & TRUST 2022 465023932 2023-03-07 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2023-03-07
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC 401(K) PLAN & TRUST 2022 465023932 2023-03-07 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2023-03-07
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC 401(K) PLAN & TRUST 2021 465023932 2022-04-13 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2022-04-13
Name of individual signing KENLEY MICHAUD
Role Employer/plan sponsor
Date 2022-04-13
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC DEFINED BENEFIT PLAN & TRUST 2021 465023932 2022-04-13 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2022-04-13
Name of individual signing KENLEY MICHAUD
Role Employer/plan sponsor
Date 2022-04-13
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC DEFINED BENEFIT PLAN & TRUST 2020 465023932 2021-03-15 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2021-03-12
Name of individual signing KENLEY MICHAUD
Role Employer/plan sponsor
Date 2021-03-12
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC 401(K) PLAN & TRUST 2020 465023932 2021-03-15 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 205 E. DIMOND BLVD. #200, ANCHORAGE, AK, 99515

Signature of
Role Plan administrator
Date 2021-03-12
Name of individual signing KENLEY MICHAUD
Role Employer/plan sponsor
Date 2021-03-12
Name of individual signing KENLEY MICHAUD
KENLEY MICHAUD DDS, INC 401(K) PLAN & TRUST 2016 465023932 2017-04-13 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor NORTHERN LIGHTS DENTAL ANESTHESIA, LLC
Business code 621210
Sponsor’s telephone number 9072683109
Plan sponsor’s address 1231 W. NORTHERN LIGHTS BOULEVARD,, SUITE 623, ANCHORAGE, AK, 99503

Signature of
Role Plan administrator
Date 2017-04-13
Name of individual signing KENLEY MICHAUD

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 1006030 Active 2014-05-19 2023-11-20 2025-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621210 - OFFICES OF DENTISTS

Date of last update: 11 Jan 2025

Sources: State of Alaska - Department of Commerce, Community, and Economic Development

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