WILLOW TREE DENTAL GROUP LLC (NPI# 1093974446) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093974446 |
| Entity Type | Organization |
| Organization Name | WILLOW TREE DENTAL GROUP LLC |
| Practice Address |
317 W Cherry Ln Meridian ID 83642-1608 |
| Practice Telephone | 2084727817 |
| Practice Fax Number | 2083452601 |
| Mailing Telephone | 2084727817 |
| Mailing Fax Number | 2083452601 |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2008-06-02 |
| Authorized Official Name | MRS. SHANNON LOVE (FINANCIAL MANAGER) |
| Authorized Official Telephone | 2084727817 |
| Is Organization Subpart | Y |
| Parent Organization Name | WILLOW TREE DENTAL GROUP LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D3443 | ID | Dental Providers |
| Street Address |
317 W CHERRY LN |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-1608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548282528 | Willowtree Dental Group Pllc | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2006-07-25 |
| 1942661038 | Willow Tree Dental Pllc | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2016-03-16 |
| 1285040394 | Blake Imam | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2014-07-09 |
| 1669643425 | William T Ritter | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2008-03-19 |
| 1083802268 | Matthew L Tuft | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2007-10-12 |
| 1629265442 | Jethe Ann Abraham | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2007-09-25 |
| 1124199237 | David M Lewis | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2006-11-11 |
| 1760553879 | John L Adams | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2006-11-11 |
| 1023189131 | Marivin Oto | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2006-11-11 |
| 1053482158 | Julie L Hess | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2006-11-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992997159 | Rodney C Richardson | Dentist | 1609 24th Ave, Meridian, MS 39301-3112 | 2007-08-13 |
| 1932171576 | Robert S Justus Sr. | Dentist | 1411 23rd Ave, Meridian, MS 39301-4024 | 2006-02-07 |
| 1306959424 | Bruce W Richardson | Dentist | 317 W Cherry Ln, Meridian, ID 83642-1608 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972968998 | Treasure Valley Periodontics | Dentist | 813 N Stilson Rd Ste C, Boise, ID 83703-5119 | 2015-12-17 |
| 1689077026 | Florence and Lincks and Associates | Dentist | 140 E Boise Ave Ste A, Boise, ID 83706-4374 | 2014-09-30 |
| 1588827125 | Richard E. Ferguson D.d.s.,m.s. Pa | Dentist | 813 Stilson Rd Ste C, Boise, ID 83703-5119 | 2008-07-03 |
| 1225255748 | Jason M Peterson | Dentist | 1980 1st St, Idaho Falls, ID 83401-4342 | 2007-04-18 |
| 1245310036 | Kenneth G. Sherman II | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2006-10-16 |
| 1497835599 | Joel Newton | Dentist | 2064 Washington Street North, Twin Falls, ID 83301 | 2006-10-16 |
| 1710096896 | Bradley J. Morlock, D.d.s.,p.c. | Dentist | 3323 4th St, Lewiston, ID 83501-4423 | 2006-08-30 |
| 1700994852 | Bradley Lynn Townsend | Dentist | 6019 N. Eagle Rd., Boise, ID 83713 | 2006-08-28 |
| 1235147281 | Michael John Florence | Dentist | 140 East Boise Avenue, Boise, ID 83706 | 2006-08-04 |
| 1346224458 | Jack H Lincks | Dentist | 140 E Boise Ave, Boise, ID 83706-4373 | 2005-12-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.