Individual
BRIANA AMBER SHACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1020 E LOCUST ST, EMMETT, ID 83617-2776
(208) 365-5064
(208) 865-1659
Mailing address
12671 W ENDSLEY LN, STAR, ID 83669-1019
(208) 608-6329
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH-4447
ID
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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