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Organization
WILLOW CREEK DENTAL PC
Active
Organization
WILLOW CREEK DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON D GORDON DDS (DENTIST)
(208) 552-0919
Entity
Organization
Contact information
Practice address
1380 LATAH AVE, IDAHO FALLS, ID 83402
(208) 552-0919
(208) 552-1010
Mailing address
PO BOX 50938, IDAHO FALLS, ID 83405-0938
(208) 552-0919
(208) 552-1010
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-4179
ID
Other
Enumeration date
05/22/2009
Last updated
05/22/2009
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