Organization
WILLOW TREE DENTAL GROUP LLC
Active
Parent organization
WILLOW TREE DENTAL GROUP LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILLOW TREE DENTAL GROUP LLC
Authorized official
MRS. SHANNON LOVE (FINANCIAL MANAGER)
(208) 472-7817
Entity
Organization
Contact information
Practice address
317 W CHERRY LN, MERIDIAN, ID 83642-1608
(208) 472-7817
(208) 345-2601
Mailing address
317 W CHERRY LN, MERIDIAN, ID 83642-1608
(208) 472-7817
(208) 345-2601
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D3443
ID
Other
Enumeration date
06/02/2008
Last updated
06/02/2008
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