NPIMap

Organization Active NPI

Applewhite Dental Illinois, P.C.

  • Dentist
  • Bloomington, IL
National Provider Identifier
1548022049
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
APPLEWHITE DENTAL ILLINOIS, P.C.
Practice address
109 N Williamsburg Dr
Bloomington, IL 61704-3528
Phone
(309) 662-3123
Fax
(309) 661-0798
NPI assigned
Jan 29, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ty Justice
Title
Director, Credentialing & Provider
Phone
(513) 808-4984

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X

Addresses

Primary practice location

109 N Williamsburg Dr
Bloomington, IL 61704-3528

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 808-4984

Other names 1

  • Signature Dental Experience Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Applewhite Dental Illinois PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

109 N Williamsburg Dr
Bloomington, IL 61704
Phone (309) 662-3123

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1548022049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-808-4984",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043528",
            "telephone_number": "309-662-3123",
            "fax_number": "309-661-0798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLEWHITE DENTAL ILLINOIS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING & PROVIDER",
        "authorized_official_telephone_number": "513-808-4984"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Signature Dental Experience",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.