# WELLPOINT DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194980417
- **Authorized official:** DR. WARREN R WILLIS DMD (CO-OWNER)
- **Authorized official phone:** (208) 887-9000

## Contact information

- **Practice address:** 2700 W CHERRY LN, MERIDIAN, ID 83642-1137
- **Practice address phone:** (208) 887-9000
- **Mailing address:** 2700 W CHERRY LN, MERIDIAN, ID 83642-1137
- **Mailing address phone:** (208) 887-9000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DH-1189 | ID | Yes |

## Other

- **Enumeration date:** 07/25/2008
- **Last updated:** 07/25/2008