Individual
DR. SHANE DANIEL VANIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
900 N LIBERTY ST STE 304, BOISE, ID 83704-8729
(208) 407-0079
Mailing address
304 SUN BURST WAY, BOISE, ID 83709-0661
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3895
ID
Other
Enumeration date
06/29/2006
Last updated
09/27/2007
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