Organization
IDAHO CITY FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE D VANIA DDS (DENTIST)
(208) 392-9900
Entity
Organization
Contact information
Practice address
219 MAIN STREET, IDAHO CITY, ID 83631
(208) 392-9900
(208) 392-9933
Mailing address
219 MAIN STREET, PO BOX 1010, IDAHO CITY, ID 83631-1010
(208) 392-9900
(208) 392-9933
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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