Individual
JULIANN COVINGTON WILLARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 587-3988
(208) 587-3324
Mailing address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 587-3988
(208) 587-3324
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-5314
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/07/2021
Last updated
03/18/2024
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