Scott Eric Tate, DDS, MS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

IN12010196A Issued in IN

Practice address

707 N Michigan St
South Bend, IN 46601-1067

Phone

(574) 289-0080

Fax

(812) 323-9701

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral Surgery Associates & Dental Implant Center PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Conyers, GA
  • NPI 1003924788
  Medicare reassignment NPD
• Bloomington Oral & Maxillofacial Surgery Group

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Bloomington, IN
  • NPI 1386762318
  NPD (past) Authorized official
• Avon Oral & Maxillofacial Surgery LLP

  • Oral and Maxillofacial Surgery (Dentist)
  • Avon, IN
  • NPI 1265479737
  NPD (past)
• Sentry Anesthesia Management, LLC

  • Anesthesiology Physician
  • Newnan, GA
  • NPI 1134544794
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1528166097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011067",
            "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": "707 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011067",
            "telephone_number": "574-289-0080",
            "fax_number": "812-323-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "SCOTT",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "IN12010196A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200494170",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dwight Lowell Tapley, M.D.
• Reagan Tapley, PT, DPT
• Amy Tarwacki, PTA
• Rebecca Tarwacki
• Schalisa Michelle Tate, MAC, MHC
• Kevin Taubman, M.D.
• Amber Taylor
• Angela Taylor
• Brent Taylor
• Cierra Taylor, RBT

• Oral and Maxillofacial Surgery (Dentist) in South Bend, IN
• Providers in South Bend, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.