MEDICARE: WHITESTONE DENTAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346110889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITESTONE DENTAL, LLC

Provider Business Mailing Address
First Line	:	1740 S SPANISH SUN WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-8024
Country	:	US
Telephone Number	:	208-370-5620
Fax Number	:	208-218-9710

Provider Business Practice Location Address
First Line	:	1740 S SPANISH SUN WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642
Country	:	US
Telephone Number	:	208-869-5702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WARREN R WILLIS
Credential	:	DMD
Telephone Number	:	208-869-5702

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	03/23/2026

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Directions to “WHITESTONE DENTAL, LLC ” Practice Location

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