Bloomington Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010765 Issued in IN

Legal business name

BLOOMINGTON DENTAL GROUP

Practice address

1600 W Bloomfield Rd
Bloomington, IN 47403-2054

Phone

(812) 323-1530

NPI assigned

May 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ryan D Tschetter, D.D.S.

Title

Dentist

Phone

(812) 323-1530

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770535916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W BLOOMFIELD RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032054",
            "telephone_number": "812-323-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W BLOOMFIELD RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032054",
            "telephone_number": "812-323-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TSCHETTER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "812-323-1530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.