Two Rivers Dental, Pllc

NPI #1114156064 in Mtn Home, Idaho

Provider Information

NPI Number: 1114156064
Entity Type: Organization
Organization Name: Two Rivers Dental, Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 13, 2009
Last Updated: Jul 13, 2009

Practice Location

Address: 125 S 10TH E
City: Mtn Home
State: Idaho
ZIP Code: 83647-3120
Phone: (208) 587-4326

Authorized Official

Name: SHANE NEWTON
Title: OWNER
Phone: (208) 587-4326

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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