NPI 1386762318

Bloomington Oral & Maxillofacial Surgery Group

Organisation Oral & Maxillofacial Surgery (D.M.D.) Bloomington, IN

Practice location

Address: 637 S Walker Street Suite 1, Bloomington, IN 47403-2154
Phone: (812) 323-9700
Fax: (812) 323-9701

Authorised official

Name: Scott E Tate
Title: Doctor President
Phone: (812) 323-9700

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence IN12010196A (IN)

Other Oral & Maxillofacial Surgery providers in Indiana →

Registry record

NPI: 1386762318
Entity type: Organization
NPI issued: 27 Mar 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.