Organization
BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT E TATE DDS MS (DOCTOR PRESIDENT)
(812) 323-9700
Entity
Organization
Contact information
Practice address
637 S WALKER STREET, SUITE 1, BLOOMINGTON, IN 47403-2154
(812) 323-9700
(812) 323-9701
Mailing address
637 S WALKER STREET, SUITE 1, BLOOMINGTON, IN 47403-2154
(812) 323-9700
(812) 323-9701
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
IN12010196A
IN
Other
Enumeration date
03/27/2007
Last updated
08/22/2020
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