| Spartan Dental Company, Llc | |
|
925 W Airbase Rd Mountain Home ID 83647-3319 | |
| (208) 590-0966 | |
| (208) 587-1906 |
| Full Name | Spartan Dental Company, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 925 W Airbase Rd, Mountain Home, Idaho |
| Authorized Official Name and Position | David Robert Borgholthaus (MANAGER) |
| Authorized Official Contact | 2085900966 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spartan Dental Company, Llc 925 W Airbase Rd Mountain Home ID 83647-3319 Ph: (208) 590-0966 | Spartan Dental Company, Llc 925 W Airbase Rd Mountain Home ID 83647-3319 Ph: (208) 590-0966 |
| NPI Number | 1932910114 |
|---|---|
| Provider Enumeration Date | 01/16/2025 |
| Last Update Date | 01/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932910114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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John E. Goodrich, D.d.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 Airbase Rd, Mountain Home, ID 83647 Phone: 208-587-3314 Fax: 208-587-3921 | |
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