NPIMap

Organization Active NPI

Two Rivers Dental, PLLC

  • General Practice Dentistry
  • MTN Home, ID
National Provider Identifier
1114156064
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3280 Issued in ID
Legal business name
TWO RIVERS DENTAL, PLLC
Practice address
125 S 10TH E
MTN Home, ID 83647-3120
Phone
(208) 587-4326
NPI assigned
Jul 13, 2009
Last updated
Jul 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shane Newton
Title
Owner
Phone
(208) 587-4326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3280 ID Primary

Addresses

Primary practice location

125 S 10TH E
MTN Home, ID 83647-3120

Mailing address

125 S 10TH E
MTN Home, ID 83647-3120
Phone (208) 587-4326

National Provider Directory

National Provider Directory
Tax ID family
Two Rivers Dental PLLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

125 S 10th E
Mtn Home, ID 83647
Phone (208) 453-6188

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1114156064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S 10TH E",
            "city": "MTN HOME",
            "state": "ID",
            "postal_code": "836473120",
            "telephone_number": "208-587-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S 10TH E",
            "city": "MTN HOME",
            "state": "ID",
            "postal_code": "836473120",
            "telephone_number": "208-587-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWO RIVERS DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "NEWTON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-587-4326"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in MTN Home, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.