# TWO RIVERS DENTAL, PLLC

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

## Provider details

- **NPI number:** 1962644260
- **Authorized official:** DR. SHANE LEE NEWTON D.M/D., P.A. (OWNER)
- **Authorized official phone:** (208) 315-2842

## Contact information

- **Practice address:** 810 HWY 93 S, CHALLIS, ID 83226
- **Practice address phone:** (208) 879-2124
- **Practice address fax:** (208) 879-2169
- **Mailing address:** PO BOX 298, CHALLIS, ID 83226-0298
- **Mailing address phone:** (208) 879-2124
- **Mailing address fax:** (208) 879-2169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3280 | ID | Yes |

## Other

- **Enumeration date:** 04/01/2009
- **Last updated:** 04/01/2009