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  5. GLACIER DENTAL, LLC

GLACIER DENTAL, LLC

Contents

Company Details

Name: GLACIER DENTAL, LLC
Jurisdiction: Alaska
Legal type: Limited Liability Company
Status: Good Standing
Date of registration: 30 Aug 2006 (18 years ago)
Entity Number: 103175
ZIP code: 99515
County: Anchorage
Place of Formation: ALASKA
Address: 8840 OLD SEWARD HWY #F, 726 E 9TH AVE, ANCHORAGE, AK 99515-6666
Mailing Address: 8811 TOLOFF ST, ANCHORAGE, AK 99507

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621210 OFFICES OF DENTISTS

Officers

Name Role
Joshua Jeon Member
Joshua J. Jeon Registered Agent

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
GLACIER DENTAL LLC DEFINED BENEFIT PLAN 2021 562609329 2022-07-13 24
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2022-07-13
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC 401(K) PLAN 2021 562609329 2022-02-24 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2022-02-24
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC DEFINED BENEFIT PLAN 2020 562609329 2021-07-29 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2021-07-29
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC 401(K) PLAN 2020 562609329 2021-07-29 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2021-07-29
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC DEFINED BENEFIT PLAN 2019 562609329 2020-10-06 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2020-10-06
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC 401(K) PLAN 2019 562609329 2020-10-06 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2020-10-06
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC DEFINED BENEFIT PLAN 2018 562609329 2019-10-14 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC 401(K) PLAN 2018 562609329 2019-10-14 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC 401(K) PLAN 2017 562609329 2018-10-09 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing JOSHUA JEON
GLACIER DENTAL LLC DEFINED BENEFIT PLAN 2017 562609329 2018-10-09 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Sponsor GLACIER DENTAL LLC
Business code 621210
Sponsor’s telephone number 9072226000
Plan sponsor’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507

Plan administrator’s name and address
Administrator’s EIN 562609329
Plan administrator’s name GLACIER DENTAL LLC
Plan administrator’s address 2421 EAST TUDOR ROAD SUITE 101, ANCHORAGE, AK, 99507
Administrator’s telephone number 9072226000

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing JOSHUA JEON

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 1035144 Active 2016-03-25 2022-10-05 2024-12-31 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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