| NPI | 1194975755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MARK HOLECEK Owner Manager 208-777-9599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3552) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2013-11-13 |