Healthcare Provider Details

I. General information

NPI: 1629890520
Provider Name (Legal Business Name): APPLEWHITE DENTAL IOWA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NICHOLAS DR
MARSHALLTOWN IA
50158-4441
US

IV. Provider business mailing address

9825 KENWOOD RD STE 200
BLUE ASH OH
45242-6252
US

V. Phone/Fax

Practice location:
  • Phone: 641-752-2752
  • Fax: 641-752-7981
Mailing address:
  • Phone: 513-808-4984
  • Fax: 513-448-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TY JUSTICE
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 513-808-4984