WILLOW CREEK DENTAL PC (NPI# 1780819516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780819516 |
| Entity Type | Organization |
| Organization Name | WILLOW CREEK DENTAL PC |
| Practice Address |
1380 Latah Ave Idaho Falls ID 83402 |
| Mailing Address |
Po Box 50938 Idaho Falls ID 83405-0938 |
| Practice Telephone | 2085520919 |
| Practice Fax Number | 2085521010 |
| Mailing Telephone | 2085520919 |
| Mailing Fax Number | 2085521010 |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2009-05-22 |
| Authorized Official Name | DR. BRANDON D GORDON (DENTIST) |
| Authorized Official Telephone | 2085520919 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
D-4179 | ID | Ambulatory Health Care Facilities |
| Street Address |
1380 LATAH AVE |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648015 | Abigail Oakley | Counselor | Tueller Counseling Services, 2275 W Broadway Suite G, Idaho Falls, ID 83402 | 2020-10-30 |
| 1265041479 | Fresenius Medical Care Snake River | Clinic/Center | 3195 South Fork Blvd, Idaho Falls, ID 83402 | 2020-07-24 |
| 1295352391 | Fresenius Medical Care Idaho Falls, LLC | Clinic/Center | 3193 South Fork Blvd, Idaho Falls, ID 83402 | 2020-07-06 |
| 1952923765 | Sterling Provider Group | Clinic/Center | 7017 Daisy Lane, Idaho Falls, ID 83402 | 2020-05-14 |
| 1528604188 | Leslie Hendrian | Massage Therapist | 86 N Kaylee Circle, Idaho Falls, ID 83402 | 2019-11-19 |
| 1154966760 | Christine Nicole Cardona | Counselor | 855 N. Captital Ave Ste 1, Idaho Falls, ID 83402 | 2019-11-07 |
| 1750847786 | Brandi S Warnke | Social Worker | 254 E Street, Suite B, Idaho Falls, ID 83402 | 2019-02-14 |
| 1013402809 | Kailey Lynn Moore | Pharmacist | 376 West 18th Street, Idaho Falls, ID 83402 | 2018-06-25 |
| 1407368616 | Jessica Owsley | Social Worker | 2275 W Broadway Ste G, Idaho Falls, ID 83402 | 2017-10-27 |
| 1427419886 | Becky Allen | Developmental Therapist | 150 Shoupe Ave, Idaho Falls, ID 83402 | 2016-03-14 |
| Find all providers in zip 83402 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275999872 | Broadway Smiles | Clinic/Center | 505 1st St Ste B, Idaho Falls, ID 83401-3929 | 2016-01-12 |
| 1659748903 | Boyle Family Dental | Clinic/Center | 1370 E 17th St, Idaho Falls, ID 83404-6270 | 2015-08-21 |
| 1346702461 | Brent Cline Dds Pllc | Clinic/Center | 749 Oxford Dr, Idaho Falls, ID 83401-4203 | 2019-04-05 |
| 1407355092 | Zimbi Dental Pllc | Clinic/Center | 1400 E 17th St, Idaho Falls, ID 83404-6269 | 2018-02-08 |
| 1508378647 | Bird Family Dental Idaho Falls, Pllc | Clinic/Center | 2960 Cortez Ave, Idaho Falls, ID 83404-7554 | 2017-10-30 |
| 1538596424 | Couch Dental Care | Clinic/Center | 2110 E 25th St, Idaho Falls, ID 83404-6475 | 2013-10-09 |
| 1669771069 | Atwood Family Dentistry | Clinic/Center | 1759 W Broadway St, Idaho Falls, ID 83402-3045 | 2011-03-24 |
| 1780904623 | Hoover Chartered | Clinic/Center | 1520 Elk Creek Dr, Idaho Falls, ID 83404-8322 | 2010-06-02 |
| 1679704647 | Comfort Care Dental of Idaho Falls, Pllc | Clinic/Center | 3550 Washington Pkwy, Idaho Falls, ID 83404-4968 | 2009-08-07 |
| 1104085935 | Moulton Periodontics, Pllc | Clinic/Center | 2375 E Sunnyside Rd, Suite I, Idaho Falls, ID 83404-8280 | 2008-06-06 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83402 |
Please comment or provide details below to improve the information on WILLOW CREEK DENTAL PC.
| 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.