Organization
SHELLEY DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R STOHL (OWNER)
(208) 357-2400
Entity
Organization
Contact information
Practice address
530 S STATE ST, SHELLEY, ID 83274
(208) 357-2400
(208) 357-2414
Mailing address
530 S STATE ST, SHELLEY, ID 83274
(208) 357-2400
(208) 357-2414
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/10/2008
Last updated
10/10/2008
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