Provider Demographics
NPI:1437638103
Name:APPLEWHITE DENTAL WISCONSIN, P.C.
Entity Type:Organization
Organization Name:APPLEWHITE DENTAL WISCONSIN, P.C.
Other - Org Name:PEWAUKEE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBO SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-1448
Mailing Address - Street 1:40 MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7641
Mailing Address - Country:US
Mailing Address - Phone:563-582-1448
Mailing Address - Fax:
Practice Address - Street 1:1231 GEORGE TOWNE DR STE D
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2756
Practice Address - Country:US
Practice Address - Phone:563-582-1448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLEWHITE DENTAL WISCONSIN, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-13
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