Bloomington Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

BLOOMINGTON ORAL SURGERY

Practice address

1116 S College Mall Rd
Bloomington, IN 47401-6178

Phone

(812) 332-2204

Fax

(812) 332-9095

NPI assigned

May 7, 2019

Last updated

May 7, 2019By 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 Jacob Devitt, DMDNPI 1164475323

Title

Owner/Oral Surgeon

Phone

(812) 332-2204

Specialties & licenses 1

Addresses

Other identifiers 1

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
• Charles G Abraham, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Indianapolis, IN
  • NPI 1003336249
  NPD (past)

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1891350575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016178",
            "telephone_number": "812-332-2204",
            "fax_number": "812-332-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016178",
            "telephone_number": "812-332-2204",
            "fax_number": "812-332-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "DEVITT",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "OWNER/ORAL SURGEON",
        "authorized_official_telephone_number": "812-332-2204",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164475323",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloomington Neurofeedback
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• Bloomington Neurospinal Chiropractic Clinic PC
• Bloomington Obstetrics and Gynecology, LLC
• Bloomington Oral & Maxillofacial Surgery Group
• Bloomington Oral Surgery LLC (Timothy J Devitt, DMD)
• Bloomington Orthopedic Spine Clinic LLC
• Bloomington Pediatric Dentistry L.L.C.
• Bloomington Pediatric Speech Therapy LLC
• Bloomington Physician Services PC

• 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 May 7, 2019; 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.