Family Dental Care LLC

Primary specialty

DentistTaxonomy code 122300000X

License

D3511 Issued in ID

Legal business name

FAMILY DENTAL CARE LLC

Practice address

925 Airbase Rd
MTN Home, ID 83647-3300

Phone

(208) 587-2222

Fax

(208) 587-9100

NPI assigned

Mar 26, 2008

Last updated

Mar 26, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Borgholthaus

Title

Office Manager

Phone

(208) 587-2222

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206489600000",
    "number": "1649442955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 AIRBASE RD",
            "city": "MTN HOME",
            "state": "ID",
            "postal_code": "836473300",
            "telephone_number": "208-587-2222",
            "fax_number": "208-587-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 AIRBASE RD",
            "city": "MTN HOME",
            "state": "ID",
            "postal_code": "836473300",
            "telephone_number": "208-587-2222",
            "fax_number": "208-587-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-26",
        "last_updated": "2008-03-26",
        "status": "A",
        "authorized_official_last_name": "BORGHOLTHAUS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-587-2222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in MTN Home, ID
• Providers in MTN Home, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.