| NPI | 1043321110 |
|---|---|
| Former Legal Business Name | ORTHODONTIC SPECIALISTS OF MAGIC VALLEY |
| Entity Type | Organization |
| Authorized Contact | SHANE L. SCHVANEVELDT Doctor Owner 208-734-4600 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3515-OR) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-09-22 |