Provider Demographics
NPI:1205394079
Name:APPLEWHITE DENTAL MINNESOTA, P.C.
Entity Type:Organization
Organization Name:APPLEWHITE DENTAL MINNESOTA, P.C.
Other - Org Name:APPLEWHITE DENTAL PARTNERS OF WORTHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-1448
Mailing Address - Street 1:40 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7654
Mailing Address - Country:US
Mailing Address - Phone:563-582-1448
Mailing Address - Fax:
Practice Address - Street 1:1027 2ND AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2380
Practice Address - Country:US
Practice Address - Phone:507-372-7339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLEWHITE DENTAL MINNESOTA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-11
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty