Provider Demographics
NPI:1679127856
Name:APPLEWHITE DENTAL WISCONSIN, P.C.
Entity type:Organization
Organization Name:APPLEWHITE DENTAL WISCONSIN, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-1448
Mailing Address - Street 1:40 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7654
Mailing Address - Country:US
Mailing Address - Phone:563-582-1448
Mailing Address - Fax:
Practice Address - Street 1:1001 N GAMMON RD STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3874
Practice Address - Country:US
Practice Address - Phone:608-831-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLEWHITE DENTAL WISCONSIN, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-26
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty