Provider Demographics
NPI:1346708112
Name:APPLEWHITE DENTAL IOWA PC
Entity Type:Organization
Organization Name:APPLEWHITE DENTAL IOWA PC
Other - Org Name:TC DENTAL PARTNERS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-808-4984
Mailing Address - Street 1:9825 KENWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6252
Mailing Address - Country:US
Mailing Address - Phone:513-609-4076
Mailing Address - Fax:513-448-0511
Practice Address - Street 1:4201 WESTOWN PKWY STE 118
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6720
Practice Address - Country:US
Practice Address - Phone:515-223-1213
Practice Address - Fax:515-453-8259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLEWHITE DENTAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-11
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty