| Bloomington Pediatric Dentistry L.l.c. | |
|
477 S Landmark Ave Bloomington IN 47403-5005 | |
| (812) 355-0855 | |
| Not Available |
| Full Name | Bloomington Pediatric Dentistry L.l.c. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 477 S Landmark Ave, Bloomington, Indiana |
| Authorized Official Name and Position | Kyle Taylor (OWNER) |
| Authorized Official Contact | 8123550855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloomington Pediatric Dentistry L.l.c. 477 S Landmark Ave Bloomington IN 47403-5005 Ph: () - | Bloomington Pediatric Dentistry L.l.c. 477 S Landmark Ave Bloomington IN 47403-5005 Ph: (812) 355-0855 |
| NPI Number | 1780850628 |
|---|---|
| Provider Enumeration Date | 05/01/2008 |
| Last Update Date | 05/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780850628 | NPI | - | NPPES |
| 200338620A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 12010198 (Indiana) | Primary |
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