# WILLOW DENTAL BELLEVUE, LLC

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

## Provider details

- **NPI number:** 1366217051
- **Authorized official:** CREED CARDON (OWNER)
- **Authorized official phone:** (918) 998-0996

## Contact information

- **Practice address:** 7511 S 36TH ST, BELLEVUE, NE 68147-1244
- **Practice address phone:** (402) 733-2281
- **Practice address fax:** (918) 235-9079
- **Mailing address:** 400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
- **Mailing address phone:** (918) 998-0996
- **Mailing address fax:** (918) 235-9079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/22/2023
- **Last updated:** 11/22/2023