# JP DENTAL - BLOOMINGTON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Campus Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497160204
- **Authorized official:** DR. JOHN PASICZNYK DDS (MANAGER)
- **Authorized official phone:** (330) 990-5055

## Contact information

- **Practice address:** 409 S DUNN ST, BLOOMINGTON, IN 47401-4822
- **Practice address phone:** (812) 339-6272
- **Mailing address:** 409 S DUNN ST, BLOOMINGTON, IN 47401-4822
- **Mailing address phone:** (812) 339-6272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011425A | IN | Yes |

## Other

- **Enumeration date:** 07/01/2014
- **Last updated:** 07/01/2014