South Central Oral & Maxillofacial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12008000/12009582 Issued in IN

Legal business name

SOUTH CENTRAL ORAL & MAXILLOFACIAL SURGERY, LLC

Practice address

2911 E Covenanter Dr
Suite B
Bloomington, IN 47401-6320

Phone

(812) 333-2614

Fax

(812) 333-4594

NPI assigned

Jan 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Timothy A Pliske, DDSNPI 1134206618

Title

Owner

Phone

(812) 333-2614

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

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

• Timothy A Pliske, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bloomington, IN
  • NPI 1134206618
  Medicare reassignment NPD Authorized official
• John Kevin Coghlan, D.D.S, M.S.D.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bloomington, IN
  • NPI 1093740433
  NPD (past)

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760461339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 E COVENANTER DR",
            "address_2": "SUITE B",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016320",
            "telephone_number": "812-333-2614",
            "fax_number": "812-333-4594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 E COVENANTER DR",
            "address_2": "SUITE B",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016320",
            "telephone_number": "812-333-2614",
            "fax_number": "812-333-4594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL ORAL & MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PLISKE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-333-2614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12008000/12009582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Anne Sorrells, RBT
• Marla J Souder, PSY.D., HSPP
• Heather Marie Souers, CTRS
• Soul Insight Counseling Services
• South Central Community Action Program (Head Start)
• Southern Indiana Anesthesiology
• Southern Indiana Family Practice Center PC (Southern Indiana Family Practice Center)
• Southern Indiana Hearing Solutions
• Southern Indiana Home Care
• Southern Indiana Pathologists

• Oral and Maxillofacial Surgery (Dentist) in Bloomington, IN
• Providers in Bloomington, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.