Organization
TWO RIVERS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE L NEWTON DMD (OWNER)
(208) 634-5255
Entity
Organization
Contact information
Practice address
307 E PARK ST STE 203, MCCALL, ID 83638-5255
(208) 634-5255
(208) 634-1047
Mailing address
307 E PARK ST STE 203, MCCALL, ID 83638-5255
(208) 634-5255
(208) 634-1047
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D3280
ID
Other
Enumeration date
03/02/2009
Last updated
03/02/2009
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