Willow Creek Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WILLOW CREEK DENTAL

Doing business as

Willow Creek Dental

Practice address

1380 Latah Avenue, Idaho Falls, Id
Idaho Falls, ID 83402

Phone

(208) 552-0919

Fax

(208) 552-1010

NPI assigned

May 27, 2025

Organization subpart

No

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

Authorized official

Name

Dorci Harris

Title

Office Manager

Phone

(208) 221-6205

Specialties & licenses 1

Addresses

Other names 1

• WILLOW CREEK DENTAL Doing business as

Locations

Practitioners 1

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

• Brandon D Gordon, DDS

  • Dentist
  • Idaho Falls, ID
  • NPI 1992968804
  NPD

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

{
    "created_epoch": "1748304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1376336925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 LATAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83402",
            "telephone_number": "208-552-0919",
            "fax_number": "208-552-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 LATAH AVENUE, IDAHO FALLS, ID",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83402",
            "telephone_number": "208-552-0919",
            "fax_number": "208-552-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-27",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "DORCI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-221-6205"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLOW CREEK DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Troy D Williams, PT
• Willard Taylor Williams
• Katelyn Rose Willis
• Robert Willis, PA-C
• Roderick Jack Willmore, M.D.
• Willow Creek Dental PC
• Willow Sage Services LLC
• Bridgette Wilson, PHARMD
• David Earl Wilson, D.D.S
• Emily Wilson

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; 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.