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371 W Fir St Shelley ID 83274-1456 | |
| (208) 357-7611 | |
| (208) 357-1805 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 371 W Fir St, Shelley, Idaho |
| Authorized Official Name and Position | Steven F Nielsen (HALF OWNER) |
| Authorized Official Contact | 2083577611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 525 Shelley ID 83274-0525 Ph: (208) 357-7611 | 371 W Fir St Shelley ID 83274-1456 Ph: (208) 357-7611 |
| NPI Number | 1194774109 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194774109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Shelley Dental, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 530 S State St, Shelley, ID 83274 Phone: 208-357-2400 Fax: 208-357-2414 | |