Organization
SOUTH CENTRAL ORAL & MAXILLOFACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY A PLISKE DDS (OWNER)
(812) 333-2614
Entity
Organization
Contact information
Practice address
2911 E COVENANTER DR, SUITE B, BLOOMINGTON, IN 47401-6320
(812) 333-2614
(812) 333-4594
Mailing address
2911 E COVENANTER DR, SUITE B, BLOOMINGTON, IN 47401-6320
(812) 333-2614
(812) 333-4594
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12008000/12009582
IN
Other
Enumeration date
01/12/2006
Last updated
08/22/2020
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