1649824830 NPI number — APPLEWHITE DENTAL WISCONSIN, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649824830 NPI number — APPLEWHITE DENTAL WISCONSIN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLEWHITE DENTAL WISCONSIN, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649824830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 MAIN ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-7654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-582-1448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5610 MEDICAL CIR STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53719-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-441-6004
Provider Business Practice Location Address Fax Number:
608-238-6777
Provider Enumeration Date:
07/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LOSO
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
563-582-1448

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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