Provider Demographics
NPI:1194975755
Name:HOLECEK FAMILY DENTAL CENTER LLC
Entity type:Organization
Organization Name:HOLECEK FAMILY DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HOLECEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-777-9599
Mailing Address - Street 1:1100 E POLSTON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-777-9599
Mailing Address - Fax:208-777-1627
Practice Address - Street 1:1100 E POLSTON AVE
Practice Address - Street 2:STE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-777-9599
Practice Address - Fax:208-777-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD35521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty