Spartan Dental Company, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SPARTAN DENTAL COMPANY, LLC

Practice address

925 W Airbase Rd
Mountain Home, ID 83647-3319

Phone

(208) 590-0966

Fax

(208) 587-1906

NPI assigned

Jan 16, 2025

Organization subpart

No

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

Authorized official

Name

David Robert Borgholthaus

Title

Manager

Phone

(208) 590-0966

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1932910114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 W AIRBASE RD",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473319",
            "telephone_number": "208-590-0966",
            "fax_number": "208-587-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 W AIRBASE RD",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473319",
            "telephone_number": "208-590-0966",
            "fax_number": "208-587-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTAN DENTAL COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "BORGHOLTHAUS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-590-0966"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Mountain Home, ID
• Providers in Mountain Home, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.