Organization
TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE LEE NEWTON DMD (OWNER)
(208) 634-5255
Entity
Organization
Contact information
Practice address
120 N A ST, GRANGEVILLE, ID 83530-1211
(200) 898-3165
Mailing address
120 N A ST, GRANGEVILLE, ID 83530-1211
(208) 983-1651
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3280
ID
Other
Enumeration date
08/18/2017
Last updated
08/18/2017
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