NPI age
17 years
Enumerated 2009-05-22
● Active Type 2 · Organization
Willow Creek Dental Pc
Willow Creek Dental Pc is 1 of 202 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Gordon
Dentist
Last NPPES update
2009-05-22
Source: monthly bulk 2026-05
How this organization compares
Across 202 active clinic/center providers in Idaho.
NPI age
17 years
↑ 9 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2009 → 2026
2009-05Enumerated in NPPES
2009
2026
Where they practice
Primary practice location
1380 Latah Ave
Idaho Falls, ID 83402
Mailing address
Po Box 50938
Idaho Falls, ID 834050938
Authorized official
Brandon D Gordon, DDS
Dentist
📞 2085520919
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.