Organization
FAMILY DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BORGHOLTHAUS (OFFICE MANAGER)
(208) 587-2222
Entity
Organization
Contact information
Practice address
925 AIRBASE RD, MTN HOME, ID 83647-3300
(208) 587-2222
(208) 587-9100
Mailing address
925 AIRBASE RD, MTN HOME, ID 83647-3300
(208) 587-2222
(208) 587-9100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3511
ID
Other
Enumeration date
03/26/2008
Last updated
03/26/2008
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