Willow Tree Dental Group LLC

NPI #1093974446 in Meridian, Idaho

Provider Information

NPI Number: 1093974446
Entity Type: Organization
Organization Name: Willow Tree Dental Group LLC
Subpart: Yes (part of a larger organization)
Parent Organization: WILLOW TREE DENTAL GROUP LLC
Primary Specialty: Dentist - Periodontics
Enumeration Date: Jun 2, 2008
Last Updated: Jun 2, 2008

Practice Location

Address: 317 W CHERRY LN
City: Meridian
State: Idaho
ZIP Code: 83642-1608
Phone: (208) 472-7817

Authorized Official

Name: MRS. SHANNON LOVE
Title: FINANCIAL MANAGER
Phone: (208) 472-7817

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X	Primary

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