Provider Demographics
NPI:1629638523
Name:APPLEWHITE DENTAL IOWA PC
Entity Type:Organization
Organization Name:APPLEWHITE DENTAL IOWA PC
Other - Org Name:GLASS ROAD FAMILY DENTISTRY
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:563-552-0058
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:563-726-7070
Practice Address - Street 1:4250 GLASS RD NE STE 220
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2500
Practice Address - Country:US
Practice Address - Phone:319-395-7207
Practice Address - Fax:319-395-0143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLEWHITE DENTAL IOWA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-13
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