Organization
BLOOMINGTON ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY JACOB DEVITT DMD (OWNER/ORAL SURGEON)
(812) 332-2204
Entity
Organization
Contact information
Practice address
1116 S COLLEGE MALL RD, BLOOMINGTON, IN 47401-6178
(812) 332-2204
(812) 332-9095
Mailing address
1116 S COLLEGE MALL RD, BLOOMINGTON, IN 47401-6178
(812) 332-2204
(812) 332-9095
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164475323
—
IN
Enumeration date
05/07/2019
Last updated
05/07/2019
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