Bloomington Dental Group
Dentist, General Practice in Bloomington, IN. Organization (NPI-2).
NPI number1770535916
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1770535916
- Entity type
- Organization (NPI-2)
- Legal business name
- Bloomington Dental Group
- Organization subpart
- No
- Enumeration date
- May 16, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 12010765 | IN | Yes |
Practice location
1600 W Bloomfield RdBloomington, IN 47403-2054
Phone 812-323-1530
Mailing address
1600 W Bloomfield RdBloomington, IN 47403-2054
Phone 812-323-1530
Authorized official
Ryan D Tschetter
Dentist
8123231530
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