Individual
CARL B HOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
350 E CEDAR ST STE A, POCATELLO, ID 83201-3709
(208) 233-2525
(208) 233-2523
Mailing address
350 E CEDAR ST STE A, POCATELLO, ID 83201-3709
(208) 233-2525
(208) 233-2523
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3326
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04083
BLUESHIELD OF ID
—
01
—
6B471
BLUECROSS OF ID
—
01
—
82029
DELTA DENTAL OF IDAHO
ID
01
—
977709
BSPA UNITED CONCORDIA
—
Enumeration date
01/17/2007
Last updated
07/08/2007
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