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NPI Code Detail

MEDICARE: WILLOWTREE DENTAL GROUP PLLC

MEDICARE: WILLOWTREE DENTAL GROUP PLLC
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
11223G0001XGeneral Practice DentistryD1820ID

General Provider Information

NPI Number : 1548282528
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOWTREE DENTAL GROUP PLLC
Provider Business Mailing Address
First Line : 317 W CHERRY LN
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1608
Country : US
Telephone Number : 208-888-2055
Fax Number : 208-327-0214
Provider Business Practice Location Address
First Line : 317 W CHERRY LN
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1608
Country : US
Telephone Number : 208-888-2055
Fax Number : 208-327-0214
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : IRENE D TURNER
Credential :
Telephone Number : 208-888-2055
Provider Enumeration Date : 07/25/2006
Last Update Date : 08/22/2020

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Directions to “WILLOWTREE DENTAL GROUP PLLC ” Practice Location

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