NPIMap

Organization Active NPI

Two Rivers Family & Cosmetic Dentistry, PA

  • Dentist
  • Grangeville, ID
National Provider Identifier
1306362587
Registry record updated Aug 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3280 Issued in ID
Legal business name
TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA
Practice address
120 N a St
Grangeville, ID 83530-1211
Phone
(200) 898-3165
NPI assigned
Aug 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2017

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

Authorized official

Name
Shane Lee Newton, DMDNPI 1619049962
Title
Owner
Phone
(208) 634-5255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D3280 ID Primary

Addresses

Primary practice location

120 N a St
Grangeville, ID 83530-1211

Mailing address

120 N a St
Grangeville, ID 83530-1211
Phone (208) 983-1651

National Provider Directory

National Provider Directory
Tax ID family
Two Rivers Family Cosmetic Dentistry PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

120 N A St
Grangeville, ID 83530
Phone (200) 898-3165

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503014400000",
    "number": "1306362587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N A ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301211",
            "telephone_number": "208-983-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N A ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301211",
            "telephone_number": "200-898-3165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2017-08-18",
        "status": "A",
        "authorized_official_last_name": "NEWTON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-634-5255",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grangeville, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; 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.