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BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY NPI 1619268265


NPI Information

NPI: 1619268265
Provider Name: BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY

Doing Business As: MARTINSVILLE ORAL & MAXILLOFACIAL SURGERY

Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
509 STATE ROAD 39 BYP S
MARTINSVILLE, IN
ZIP 46151
Phone: (765) 352-9700
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BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY is an oral and maxillofacial surgery dentist in Martinsville, IN. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY NPI is 1619268265. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Martinsville Oral & Maxillofacial Surgery.

The provider's business location address is:

509 STATE ROAD 39 BYP S
MARTINSVILLE, IN
ZIP 46151-972
Phone: (765) 352-9700
Fax: (765) 352-9701

The provider's authorized official is Scott E Tate .
The authorized official title is Owner and has the following contact phone number (812) 323-9700.

The enumeration date for this NPI number is 4/29/2011 and was last updated on 4/29/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery12010196INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200448260MEDICAIDINDIANA
2V01269MEDICARE UPIN
3228510MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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