# IDAHO CITY FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1992964597
- **Authorized official:** DR. SHANE D VANIA DDS (DENTIST)
- **Authorized official phone:** (208) 392-9900

## Contact information

- **Practice address:** 219 MAIN STREET, IDAHO CITY, ID 83631
- **Practice address phone:** (208) 392-9900
- **Practice address fax:** (208) 392-9933
- **Mailing address:** 219 MAIN STREET, PO BOX 1010, IDAHO CITY, ID 83631-1010
- **Mailing address phone:** (208) 392-9900
- **Mailing address fax:** (208) 392-9933

## Taxonomy

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

## Other

- **Enumeration date:** 06/09/2008
- **Last updated:** 06/09/2008