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1320 W Bloomfield Rd Bloomington IN 47403-2001 | |
| (812) 339-7743 | |
| (812) 339-7383 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1320 W Bloomfield Rd, Bloomington, Indiana |
| Authorized Official Name and Position | All Credentialing (CREDENTIALING) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1320 W Bloomfield Rd Bloomington IN 47403-2001 Ph: (812) 339-7743 | 1320 W Bloomfield Rd Bloomington IN 47403-2001 Ph: (812) 339-7743 |
| NPI Number | 1578785036 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 11/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578785036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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