Organization
WILLOW DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILY DAVIS (CREDENTIALING SPECIALIST)
(918) 998-0996
Entity
Organization
Contact information
Practice address
5709 NW RADIAL HWY, OMAHA, NE 68104-4141
(402) 551-1757
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
(918) 310-1056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/03/2021
Last updated
02/06/2023
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