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General NPI Number Information
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NPI Number | 1043321110
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Entity Type | Organization
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Legal Business Name | FALLS ORTHODONTICS PLLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 2085 DAWSON DR.
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 208-734-4600
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Fax | 208-734-4607
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Provider Business Mailing Address
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Address Line | 2085 DAWSON DR.
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 208-734-4600
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Fax | 208-734-4607
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Authorized Official
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Title or Position | DOCTOR-OWNER
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Name | DR. SHANE L. SCHVANEVELDT
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Credential | M.CI.D.
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Telephone | 208-734-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D-3515-OR
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License Number State | ID
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