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Organization
BLOOMINGTON ORAL SURGERY LLC
Active
Organization
BLOOMINGTON ORAL SURGERY LLC
Active
Other names
Timothy J Devitt, DMD
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY DEVITT DMD (OWNER)
(812) 332-2204
Entity
Organization
Contact information
Practice address
857 S AUTO MALL RD, BLOOMINGTON, IN 47401-5447
(812) 332-2204
(821) 332-9095
Mailing address
857 S AUTO MALL RD, BLOOMINGTON, IN 47401-5447
(812) 332-2204
(821) 332-9095
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0652A
IN
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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