# BLOOMINGTON ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891350575
- **Authorized official:** TIMOTHY JACOB DEVITT DMD (OWNER/ORAL SURGEON)
- **Authorized official phone:** (812) 332-2204

## Contact information

- **Practice address:** 1116 S COLLEGE MALL RD, BLOOMINGTON, IN 47401-6178
- **Practice address phone:** (812) 332-2204
- **Practice address fax:** (812) 332-9095
- **Mailing address:** 1116 S COLLEGE MALL RD, BLOOMINGTON, IN 47401-6178
- **Mailing address phone:** (812) 332-2204
- **Mailing address fax:** (812) 332-9095

## Taxonomy

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

## Other

- **Enumeration date:** 05/07/2019
- **Last updated:** 05/07/2019