Provider Demographics
NPI:1760471783
Name:HOLECEK, DAVID M (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:HOLECEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 E PACKSADDLE DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7923
Mailing Address - Country:US
Mailing Address - Phone:208-686-1110
Mailing Address - Fax:208-686-0242
Practice Address - Street 1:1115 B ST
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851-0388
Practice Address - Country:US
Practice Address - Phone:208-686-1931
Practice Address - Fax:208-686-0242
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3552SS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice