# TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA

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

## Provider details

- **NPI number:** 1821380346
- **Authorized official:** CLAUDETTE KIM MEYER (OFFICE MANGER)
- **Authorized official phone:** (208) 634-5255

## Contact information

- **Practice address:** 307 E PARK ST STE 103, MCCALL, ID 83638-3863
- **Practice address phone:** (208) 634-5255
- **Practice address fax:** (208) 634-1047
- **Mailing address:** 307 E PARK ST, SUITE 203, MCCALL, ID 83638-3863
- **Mailing address phone:** (208) 634-5255
- **Mailing address fax:** (208) 634-1047

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3076 | ID | Yes |
| 261QD0000X | Dental Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 05/03/2011
- **Last updated:** 11/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | M8074016 | — | ID |