Organization
JP DENTAL - BLOOMINGTON, LLC
Active
Other names
Campus Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN PASICZNYK DDS (MANAGER)
(330) 990-5055
Entity
Organization
Contact information
Practice address
409 S DUNN ST, BLOOMINGTON, IN 47401-4822
(812) 339-6272
Mailing address
409 S DUNN ST, BLOOMINGTON, IN 47401-4822
(812) 339-6272
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011425A
IN
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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