Organization
TWO RIVERS DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE LEE NEWTON D.M/D., P.A. (OWNER)
(208) 315-2842
Entity
Organization
Contact information
Practice address
810 HWY 93 S, CHALLIS, ID 83226
(208) 879-2124
(208) 879-2169
Mailing address
PO BOX 298, CHALLIS, ID 83226-0298
(208) 879-2124
(208) 879-2169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3280
ID
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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