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Organization

SPARTAN DENTAL COMPANY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID ROBERT BORGHOLTHAUS (MANAGER)
(208) 590-0966
Entity
Organization

Contact information

Practice address
925 W AIRBASE RD, MOUNTAIN HOME, ID 83647-3319
(208) 590-0966
(208) 587-1906
Mailing address
925 W AIRBASE RD, MOUNTAIN HOME, ID 83647-3319
(208) 590-0966
(208) 587-1906

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
01/16/2025
Last updated
01/16/2025
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