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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