Organization
BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY
Active
Other names
Martinsville Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT E TATE DDS, MS (OWNER)
(812) 323-9700
Entity
Organization
Contact information
Practice address
509 STATE ROAD 39 BYP S, MARTINSVILLE, IN 46151-1972
(765) 352-9700
(765) 352-9701
Mailing address
509 STATE ROAD 39 BYP S, MARTINSVILLE, IN 46151-1972
(765) 352-9700
(765) 352-9701
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010196
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200448260
—
IN
Enumeration date
04/29/2011
Last updated
04/29/2011
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