Willow Tree Dental Group Llc

NPI 1093974446 - Dentist - 1223P0300X

NPI Details
NPI 1093974446
Enumeration Date 06/02/2008
Last Updated 06/02/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name SHANNON SHANNON
Position FINANCIAL MANAGER
Phone (208) 472-7817
Fax (208) 345-2601
Practice Location
317 W CHERRY LN
MERIDIAN ID, 83642-1608, US
Phone (208) 472-7817
Fax (208) 345-2601
Business Location
317 W CHERRY LN
MERIDIAN ID, 83642-1608, US
Phone (208) 472-7817
Fax (208) 345-2601
Toxanomy
Taxonomy Code 1223P0300X
License State Idaho
License Number D3443
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According to our database, Willow Tree Dental Group Llc NPI is 1093974446, taxonomy code is 1223P0300X and license number is D3443, license state is located at Idaho. Willow Tree Dental Group Llc physically located at 317 W Cherry Ln, Meridian ID, 83642-1608. NPI Number 1033115704 has the healthcare provider type.

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1093974446 NPI number is provided on an as is basis without warranty of any kind. 1093974446 is maintained by the National Plan & Provider Enumeration System. The contents of Willow Tree Dental Group Llc are for informational purposes only.