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Organization
TWO RIVERS DENTAL, PLLC
Active
Organization
TWO RIVERS DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JED C SNOW D.M.D. (DENTIST)
(208) 588-3316
Entity
Organization
Contact information
Practice address
304 S MAIN ST, MACKAY, ID 83251
(208) 588-3316
(208) 588-3166
Mailing address
PO BOX 86, 304 S MAIN ST, MACKAY, ID 83251
(208) 588-3316
(208) 588-3166
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4109
ID
Other
Enumeration date
02/07/2011
Last updated
02/07/2011
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