Willow Tree Dental Group LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D3443 Issued in ID

Legal business name

WILLOW TREE DENTAL GROUP LLC

Practice address

317 W Cherry LN
Meridian, ID 83642-1608

Phone

(208) 472-7817

Fax

(208) 345-2601

NPI assigned

Jun 2, 2008

Organization subpart

Yes

Parent organization

WILLOW TREE DENTAL GROUP LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shannon Love

Title

Financial Manager

Phone

(208) 472-7817

Specialties & licenses 1

Addresses

Part of

Willow Tree Dental Group PLLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1093974446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 W CHERRY LN",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421608",
            "telephone_number": "208-472-7817",
            "fax_number": "208-345-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 W CHERRY LN",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421608",
            "telephone_number": "208-472-7817",
            "fax_number": "208-345-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE DENTAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLOW TREE DENTAL GROUP LLC",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "LOVE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "208-472-7817",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D3443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Willis, D.C.
• Taylor Lynne Willis, OTR/L
• Laura Kathleen Willoughby, M.S. CCC-SLP
• Scott Donald Willoughby, FNP-C
• Willow and Stone Counseling LLC
• Willow Tree Dental PLLC
• Willowtree Dental Group PLLC
• Andrew Perry Wilson
• Anne Kelly Wilson, DO
• James Miller Wilson V, MD

• Periodontics in Meridian, ID
• Providers in Meridian, ID by specialty
• Periodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.