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615 N Walnut St Bloomington IN 47404-3811 | |
| (812) 332-8290 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 615 N Walnut St, Bloomington, Indiana |
| Authorized Official Name and Position | Martin Thomas Barco (OWNER/PRESIDENT) |
| Authorized Official Contact | 7543461481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
615 N Walnut St Bloomington IN 47404-3811 Ph: (812) 332-8290 | 615 N Walnut St Bloomington IN 47404-3811 Ph: (812) 332-8290 |
| NPI Number | 1780187674 |
|---|---|
| Provider Enumeration Date | 03/16/2018 |
| Last Update Date | 03/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780187674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 12011246A (Indiana) | Primary |
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