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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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