Bloomington Oral Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0652A Issued in IN

Legal business name

BLOOMINGTON ORAL SURGERY LLC

Doing business as

Timothy J Devitt, DMD

Practice address

857 S Auto Mall Rd
Bloomington, IN 47401-5447

Phone

(812) 332-2204

Fax

(821) 332-9095

NPI assigned

Aug 10, 2010

Last updated

Aug 10, 2010By 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

Timothy Devitt, DMDNPI 1164475323

Title

Owner

Phone

(812) 332-2204

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Timothy J Devitt, DMD Doing business as

Practitioners 2

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.

• Timothy J Devitt, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bloomington, IN
  • NPI 1164475323
  NPD (past) Authorized official
• Thomas W Gibbs, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Bloomington, IN
  • NPI 1497798136
  NPD (past)

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

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1841505252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "857 S AUTO MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015447",
            "telephone_number": "812-332-2204",
            "fax_number": "821-332-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "857 S AUTO MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015447",
            "telephone_number": "812-332-2204",
            "fax_number": "821-332-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ORAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-10",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "DEVITT",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-332-2204",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "0652A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200809540A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timothy J Devitt, DMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 10, 2010; 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.