Willow River Dental PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

WILLOW RIVER DENTAL PLLC

Practice address

625 E Liberty St Ste 202
Ann Arbor, MI 48104-2013

Phone

(734) 668-6612

NPI assigned

Dec 6, 2023

Organization subpart

No

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

Authorized official

Name

Katherine Ann Latendresse, DDSNPI 1093384364

Title

Owner

Phone

(906) 201-0852

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katherine Ann Latendresse, DDS

  • General Practice Dentistry
  • Jackson, MI
  • NPI 1093384364
  NPD Authorized official
• Kimberlee Jessica Karey, DDS

  • Dentist
  • Ann Arbor, MI
  • NPI 1033292156
  NPD (past)

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

{
    "created_epoch": "1701820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1316714728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E LIBERTY ST STE 202",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481042013",
            "telephone_number": "734-668-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E LIBERTY ST STE 202",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481042013",
            "telephone_number": "734-668-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW RIVER DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "LATENDRESSE",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "906-201-0852",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jean Willis, LMSW
• Elizabeth Clare Willoughby
• Kimberly Willoughby
• Shamim Willoughby, CRNA
• Willow Integrated Therapy
• Rachel Marie Wills, OTRL
• Matthew Steven Willsey, MD
• Karla J Willson, NP
• Zachary Marcus Wilseck, M.D.
• Madelyn Rena Wilson Patterson, RN

• All providers in Ann Arbor, MI
• Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.