Organization
TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDETTE KIM MEYER (OFFICE MANGER)
(208) 634-5255
Entity
Organization
Contact information
Practice address
307 E PARK ST STE 103, MCCALL, ID 83638-3863
(208) 634-5255
(208) 634-1047
Mailing address
307 E PARK ST, SUITE 203, MCCALL, ID 83638-3863
(208) 634-5255
(208) 634-1047
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3076
ID
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M8074016
—
ID
Enumeration date
05/03/2011
Last updated
11/15/2022
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