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Organization
BLOOMINGTON SOUTHSIDE DENTAL CARE. LLC
Active
Organization
BLOOMINGTON SOUTHSIDE DENTAL CARE. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL RENE REITMEYER DDS (OWNER)
(812) 824-4444
Entity
Organization
Contact information
Practice address
191 W GORDON PIKE, BLOOMINGTON, IN 47403-4518
(812) 824-4444
Mailing address
191 W GORDON PIKE, BLOOMINGTON, IN 47403-4518
(812) 824-4444
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114439189
NAREY NPI
IN
01
—
1720370059
PERSONAL NPI
IN
Enumeration date
04/05/2022
Last updated
04/05/2022
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