Shelley Dental, INC

NPI #1174775902 in Shelley, Idaho

Provider Information

NPI Number: 1174775902
Entity Type: Organization
Organization Name: Shelley Dental, INC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 10, 2008
Last Updated: Oct 10, 2008

Practice Location

Address: 530 S STATE ST
City: Shelley
State: Idaho
ZIP Code: 83274
Phone: (208) 357-2400

Authorized Official

Name: JOHN R STOHL
Title: OWNER
Phone: (208) 357-2400

Specialties & Taxonomy Codes

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

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