# TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306362587
- **Authorized official:** SHANE LEE NEWTON DMD (OWNER)
- **Authorized official phone:** (208) 634-5255

## Contact information

- **Practice address:** 120 N A ST, GRANGEVILLE, ID 83530-1211
- **Practice address phone:** (200) 898-3165
- **Mailing address:** 120 N A ST, GRANGEVILLE, ID 83530-1211
- **Mailing address phone:** (208) 983-1651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3280 | ID | Yes |

## Other

- **Enumeration date:** 08/18/2017
- **Last updated:** 08/18/2017