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Organization
FACIAL ORAL AND DENTAL IMPLANT SURGERY ASSOCIATES, INC.
Active
Organization
FACIAL ORAL AND DENTAL IMPLANT SURGERY ASSOCIATES, INC.
Active
Other names
Oral and Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN WILFORD HOLM DMD (OWNER)
(208) 743-1640
Entity
Organization
Contact information
Practice address
3326 4TH ST STE 2, LEWISTON, ID 83501-4455
(208) 743-1640
(208) 743-1643
Mailing address
3326 4TH ST STE 2, LEWISTON, ID 83501-4455
(208) 743-1640
(208) 743-1643
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-4057
ID
Other
Enumeration date
11/10/2008
Last updated
04/14/2011
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