Bloomington Oral & Maxillofacial Surgery Group

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

IN12010196A Issued in IN

Legal business name

BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY GROUP

Practice address

637 S Walker Street
Suite 1
Bloomington, IN 47403-2154

Phone

(812) 323-9700

Fax

(812) 323-9701

NPI assigned

Mar 27, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Scott E Tate, DDS MSNPI 1528166097

Title

Doctor President

Phone

(812) 323-9700

Specialties & licenses 1

Addresses

Tax ID family

Bloomington Oral Maxillofacial Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bloomington Oral & Maxillofacial Surgery

  dba Martinsville Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Martinsville, IN
  • NPI 1619268265
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott Eric Tate, DDS, MS

  • Oral and Maxillofacial Surgery (Dentist)
  • South Bend, IN
  • NPI 1528166097
  NPD (past) Authorized official

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386762318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 S WALKER STREET",
            "address_2": "SUITE 1",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032154",
            "telephone_number": "812-323-9700",
            "fax_number": "812-323-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 S WALKER STREET",
            "address_2": "SUITE 1",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032154",
            "telephone_number": "812-323-9700",
            "fax_number": "812-323-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DOCTOR PRESIDENT",
        "authorized_official_telephone_number": "812-323-9700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IN",
            "license": "IN12010196A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloomington Meadows GP -
• Bloomington Neurofeedback
• Bloomington Neurology, PC
• Bloomington Neurospinal Chiropractic Clinic PC
• Bloomington Obstetrics and Gynecology, LLC
• Bloomington Oral Surgery
• Bloomington Oral Surgery LLC (Timothy J Devitt, DMD)
• Bloomington Orthopedic Spine Clinic LLC
• Bloomington Pediatric Dentistry L.L.C.
• Bloomington Pediatric Speech Therapy LLC

• Oral & Maxillofacial Surgery (D.M.D.) in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.