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  5. OTTER DENTAL PC

OTTER DENTAL PC

Contents

Company Details

Name: OTTER DENTAL PC
Jurisdiction: Alaska
Legal type: Professional Corporation
Status: Good Standing
Date of registration: 18 Jul 2016 (8 years ago)
Entity Number: 10040272
ZIP code: 99701
County: Fairbanks North Star
Place of Formation: ALASKA
Address: 1870 PEGER RD, FAIRBANKS, AK 99701

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621210 OFFICES OF DENTISTS

Officers

Name Role
ERICH OTT Shareholder
ERICH OTT Director
ERICH OTT President
ERICH OTT Secretary
ERICH OTT Treasurer
ERICH OTT Vice President
ERICH OTT Registered Agent

Unique Entity ID

Unique Entity ID Expiration Date Physical Address
FT1UNW39RNH4 2024-07-09 1870 PEGER RD, FAIRBANKS, AK, 99709, USA
Mailing Address 1870 PEGER RD, FAIRBANKS, AK, 99709, USA

Business Information
URL www.otterdental.com
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2023-07-12
Initial Registration Date 2023-07-10
Entity Start Date 2017-01-01
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name NICOLE OTT
Address 1870 PEGER RD, FAIRBANKS, AK, 99709, 5256, USA
Government Business
Title PRIMARY POC
Name ERICH OTT
Address 1870 PEGER RD, FAIRBANKS, AK, 99709, 5256, USA
Past Performance -

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
OTTER DENTAL PC 401(K) PLAN 2023 813905789 2024-06-13 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2023-01-01
Sponsor OTTER DENTAL PC
Business code 621210
Sponsor’s telephone number 9078886966
Plan sponsor’s address 1870 PEGER RD, FAIRBANKS, AK, 99709

Plan administrator’s name and address
Administrator’s EIN 842925395
Plan administrator’s name 401GO, INC.
Plan administrator’s address 8427 OLD BINGHAM HWY, WEST JORDAN, UT, 84088
Administrator’s telephone number 8012142125

Signature of
Role Plan administrator
Date 2024-06-13
Name of individual signing FIDUCIARY ASSISTANCE
OTTER DENTAL MEDOVA LIFESTYLE HEALTH PLAN 2021 813905789 2024-08-29 0
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-11-01
Sponsor OTTER DENTAL
Business code 621210
Sponsor’s telephone number 9074527007
Plan sponsor’s address 1870 PEGER RD, FAIRBANKS, AK, 997095256

Plan administrator’s name and address
Administrator’s EIN 200200514
Plan administrator’s name RECEIVERSHIP MANAGEMENT INC
Plan administrator’s address 510 HOSPITAL DR STE 490, MADISON, TN, 371155049
Administrator’s telephone number 6153700051

Signature of
Role Plan administrator
Date 2024-08-29
Name of individual signing ROBERT MOORE
OTTER DENTAL MEDOVA LIFESTYLE HEALTH PLAN 2020 813905789 2022-07-28 5
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-11-01
Sponsor OTTER DENTAL
Business code 621210
Sponsor’s telephone number 9074527007
Plan sponsor’s address 1870 PEGER RD, FAIRBANKS, AK, 997095256

Plan administrator’s name and address
Administrator’s EIN 200200514
Plan administrator’s name RECEIVERSHIP MANAGEMENT INC
Plan administrator’s address 510 HOSPITAL DR STE 490, MADISON, TN, 371155049
Administrator’s telephone number 6153700051

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing ROBERT MOORE

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 1072086 Active 2018-05-04 2023-10-16 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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