# BLOOMINGTON SOUTHSIDE DENTAL CARE. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437890290
- **Authorized official:** DR. JILL RENE REITMEYER DDS (OWNER)
- **Authorized official phone:** (812) 824-4444

## Contact information

- **Practice address:** 191 W GORDON PIKE, BLOOMINGTON, IN 47403-4518
- **Practice address phone:** (812) 824-4444
- **Mailing address:** 191 W GORDON PIKE, BLOOMINGTON, IN 47403-4518
- **Mailing address phone:** (812) 824-4444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/05/2022
- **Last updated:** 04/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1114439189 | NAREY NPI | IN |
| 01 | — | 1720370059 | PERSONAL NPI | IN |