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General NPI Number Information
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NPI Number | 1619049962
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Entity Type | Individual
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Provider Name | SHANE LEE NEWTON DMD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 307 E PARK ST STE 103
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City | MCCALL
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State | ID
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Zip | 83638-3863
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Country | US
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Telephone | 208-634-5255
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Fax | 208-634-1047
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Provider Business Mailing Address
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Address Line | 307 E PARK ST STE 103
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City | MCCALL
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State | ID
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Zip | 83638-3863
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Country | US
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Telephone | 208-634-5255
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Fax | 208-634-1047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3280
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License Number State | ID
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