| Bloomington Oral Surgery | |
|
1116 S College Mall Rd Bloomington IN 47401-6178 | |
| (812) 332-2204 | |
| (812) 332-9095 |
| Full Name | Bloomington Oral Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1116 S College Mall Rd, Bloomington, Indiana |
| Authorized Official Name and Position | Timothy Jacob Devitt (OWNER/ORAL SURGEON) |
| Authorized Official Contact | 8123322204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloomington Oral Surgery 1116 S College Mall Rd Bloomington IN 47401-6178 Ph: (812) 332-2204 | Bloomington Oral Surgery 1116 S College Mall Rd Bloomington IN 47401-6178 Ph: (812) 332-2204 |
| NPI Number | 1891350575 |
|---|---|
| Provider Enumeration Date | 05/07/2019 |
| Last Update Date | 05/07/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891350575 | NPI | - | NPPES |
| 1164475323 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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