# BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Martinsville Oral & Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619268265
- **Authorized official:** DR. SCOTT E TATE DDS, MS (OWNER)
- **Authorized official phone:** (812) 323-9700

## Contact information

- **Practice address:** 509 STATE ROAD 39 BYP S, MARTINSVILLE, IN 46151-1972
- **Practice address phone:** (765) 352-9700
- **Practice address fax:** (765) 352-9701
- **Mailing address:** 509 STATE ROAD 39 BYP S, MARTINSVILLE, IN 46151-1972
- **Mailing address phone:** (765) 352-9700
- **Mailing address fax:** (765) 352-9701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010196 | IN | Yes |

## Other

- **Enumeration date:** 04/29/2011
- **Last updated:** 04/29/2011