Healthcare Provider Details

I. General information

NPI: 1588721062
Provider Name (Legal Business Name): ADAM M. HOLECEK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 N. 12TH STREET
PLUMMER ID
83851
US

IV. Provider business mailing address

6950 NE CAMPUS WAY
HILLSBORO OR
97124-5611
US

V. Phone/Fax

Practice location:
  • Phone: 208-686-1931
  • Fax: 208-686-0123
Mailing address:
  • Phone: 503-952-2164
  • Fax: 503-526-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-3825
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: