Organization
TWO RIVERS DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE NEWTON (OWNER)
(208) 587-4326
Entity
Organization
Contact information
Practice address
125 S 10TH E, MTN HOME, ID 83647-3120
(208) 587-4326
Mailing address
125 S 10TH E, MTN HOME, ID 83647-3120
(208) 587-4326
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3280
ID
Other
Enumeration date
07/13/2009
Last updated
07/13/2009
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