Bloomington Oral Surgery

LBN: Bloomington Oral Surgery
Bloomington Oral Surgery is an health care organization with primary practice located at 1116 S College Mall Rd , Bloomington IN 47401-6178. The organization recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as the primary health care specialty. Bloomington Oral Surgery can be contacted via phone (812) 332-2204, or through Devitt, Timothy Jacob via phone (812) 332-2204.

Contact Information

Primary practice address
1116 S College Mall Rd Bloomington IN 47401-6178
Phone: (812) 332-2204
Fax: (812) 332-9095
Website:
Map and Directions
Authorized official contact:
Name: Devitt, Timothy Jacob Doctor of Dental Medicine (DMD)
Phone: (812) 332-2204

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X

Profile Details

NPI number 1891350575
LBN Legal business name Bloomington Oral Surgery
DBA Doing business as
Authorized official Devitt, Timothy Jacob Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date May 7th, 2019
Last updated May 7th, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891350575 NPPES
Indiana MEDICAID 1164475323

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