Willow Dental Papillion LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WILLOW DENTAL PAPILLION LLC

Practice address

8410 S 73Rd PLZ Ste 106
Papillion, NE 68046-1514

Phone

(402) 592-2219

NPI assigned

Jun 14, 2022

Last updated

Nov 8, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Creed Cardon

Title

Owner

Phone

(918) 998-0996

Specialties & licenses 2

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Gritzuk, DDS

  • General Practice Dentistry
  • Papillion, NE
  • NPI 1982981692
  NPD
• Katie Keck, DDS

  • General Practice Dentistry
  • Papillion, NE
  • NPI 1407471261
  NPD
• Jacob Dawson, DMD

  • Dentist
  • Omaha, NE
  • NPI 1346863131
  NPD (past)

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1629708417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8410 S 73RD PLZ STE 106",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680461514",
            "telephone_number": "402-592-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW DENTAL PAPILLION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-14",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "CARDON",
        "authorized_official_first_name": "CREED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-998-0996"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Ruth Williams
• Kiley Renee Williamson
• Jessica Williar
• Matthew Luke Willis, O.D.
• Rosemary Willis
• Derek Jason Wills, OD
• Mackenzie Breanne Wills
• Caitlin Helene Wilsey, RN
• Camene E. Wilson, PHARMD
• Daniel Lamont Wilson

• Dental Clinic/Center in Papillion, NE
• Providers in Papillion, NE by specialty
• Dental Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.