Periodontal Associates of Bloomington

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

PERIODONTAL ASSOCIATES OF BLOOMINGTON

Practice address

230 N Morton St
Bloomington, IN 47404-3964

Phone

(812) 323-7000

NPI assigned

Jul 29, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Villanueva

Title

Operations Manager

Phone

(630) 532-1063

Specialties & licenses 1

Addresses

Other names 1

• Midwest Dental Specialists Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Ellis Phillips, DDS, MSD

  • Periodontics
  • Bloomington, IN
  • NPI 1417022427
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753747200000",
    "number": "1386527059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 N MORTON ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 N MORTON ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043964",
            "telephone_number": "812-323-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL ASSOCIATES OF BLOOMINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "630-532-1063"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mollibeth Penner
• Linnea Pennycuff, R.D., C.D.
• Ursula Penrose, N.P.
• Carrie Pepper
• Hannah Perin, RBT
• Peripheral Vascular Care
• Avis Kathleen Perkins, PHARMD
• Grace Perkins
• Jeffrey D. Perotti, O.D.
• Laura Verwilst Perron, OD

• Periodontics in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Periodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.