Organization
APPLEWHITE DENTAL ILLINOIS, P.C.
Active
Other names
Signature Dental Experience
Organization subpart
No
Provider details
NPI number
Authorized official
TY JUSTICE (DIRECTOR, CREDENTIALING & PROVIDER)
(513) 808-4984
Entity
Organization
Contact information
Practice address
109 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 662-3123
(309) 661-0798
Mailing address
9825 KENWOOD RD STE 200, BLUE ASH, OH 45242-6252
(513) 808-4984
(513) 448-0511
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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