SOUTH CENTRAL ORAL & MAXILLOFACIAL SURGERY, LLC (NPI# 1760461339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760461339 |
| Entity Type | Organization |
| Organization Name | SOUTH CENTRAL ORAL & MAXILLOFACIAL SURGERY, LLC |
| Practice Address |
2911 E Covenanter Dr Suite B Bloomington IN 47401-6320 |
| Practice Telephone | 8123332614 |
| Practice Fax Number | 8123334594 |
| Mailing Telephone | 8123332614 |
| Mailing Fax Number | 8123334594 |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. TIMOTHY A PLISKE (OWNER) |
| Authorized Official Telephone | 8123332614 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12008000/1200958 | IN | Dental Providers |
| Street Address |
2911 E COVENANTER DR SUITE B |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47401-6320 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518082643 | Coghlan Orthodontics | Dentist | 2911 E Covenanter Dr, Bloomington, IN 47401-6320 | 2007-03-20 |
| 1073637450 | Charles Y. Coghlan | Dentist | 2911 E Covenanter Dr, Bloomington, IN 47401-6320 | 2007-03-19 |
| 1134206618 | Timothy A Pliske | Dentist | 2911 E Covenanter Dr, Suite B, Bloomington, IN 47401-6320 | 2006-11-01 |
| 1144307521 | David J Howell | Dentist | 2911 E Covenanter Dr, Suite B, Bloomington, IN 47401-6320 | 2006-11-01 |
| 1093740433 | John Kevin Coghlan | Dentist | 2911 E Covenanter Dr, Bloomington, IN 47401-6320 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740765791 | Holly G Carter | Physical Therapist | 3607 Heirloom Dr, Bloomington, IN 47401 | 2018-09-26 |
| 1285116657 | Kimberly D Bergan | Occupational Therapist | 3607 S Heirloom Dr, Bloomington, IN 47401 | 2018-09-03 |
| 1255836813 | Erin Kathleen Sain | Nurse Practitioner | 326 W Woodcrest Drive, Bloomington, IN 47401 | 2018-03-27 |
| 1881104289 | Ev Bloomington Limited Partnership | Assisted Living Facility | 3607 South Heirloom Drive, Bloomington, IN 47401 | 2017-10-11 |
| 1619496536 | Kirsten N Neely | Physical Therapist | 2604 E. Creek's Edge Dr., Bloomington, IN 47401 | 2017-09-12 |
| 1023533908 | Hoosier United Therapy Service LLC | Physical Therapist | 2801 E Plateau Place, Bloomington, IN 47401 | 2017-08-11 |
| 1194127381 | Ann Marie Neeley | Lactation Consultant, Non-RN | 2458 South Walnut Street, Bloomington, IN 47401 | 2014-09-19 |
| 1518397801 | Indiana Spine and Sports Inc. | Chiropractor | 418 S Walnut St Suite C, Bloomington, IN 47401 | 2013-11-22 |
| 1053654574 | William Robblee Anderson | Obstetrics & Gynecology | 2625 E. Spicewood Ct., Bloomington, IN 47401 | 2013-04-03 |
| 1285979377 | Jenna Marie Dale | Optometrist | 322 S. Woodcrest Drive Precision Eye Group, Bloomington, IN 47401 | 2012-11-30 |
| Find all providers in zip 47401 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568878270 | Austin Starr | Dentist | 473 S Landmark Ave, Bloomington, IN 47403-5005 | 2014-07-02 |
| 1669533964 | Richard J Claydon | Dentist | 107 S Prospect, Bloomington, IL 61704 | 2006-12-12 |
| 1528166097 | Scott Eric Tate | Dentist | 637 S Walker St, Ste 1, Bloomington, IN 47403-2154 | 2006-09-20 |
| 1497798136 | Thomas W Gibbs | Dentist | 857 Auto Mall Rd, Bloomington, IN 47440-5447 | 2006-06-13 |
| 1164475323 | Timothy J Devitt | Dentist | 1116 S College Mall Rd, Bloomington, IN 47401-6178 | 2006-05-18 |
| 1710985759 | Drs Doran Capodice Efaw & Ocheltree LLC | Dentist | 109 N Regency Dr, Bloomington, IL 61701-3515 | 2005-07-13 |
| 1356978753 | Starr Oral & Maxillofacial Surgery, LLC | Dentist | 473 S Landmark Ave, Bloomington, IN 47403-5005 | 2020-03-25 |
| 1891350575 | Bloomington Oral Surgery | Dentist | 1116 S College Mall Rd, Bloomington, IN 47401-6178 | 2019-05-07 |
| 1841505252 | Bloomington Oral Surgery LLC | Dentist | 857 S Auto Mall Rd, Bloomington, IN 47401-5447 | 2010-08-10 |
| 1437291895 | Craig Walter Lopatka | Dentist | 2502 E Empire St Ste B, Bloomington, IL 61704-3739 | 2007-02-13 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47401 |
Please comment or provide details below to improve the information on SOUTH CENTRAL ORAL & MAXILLOFACIAL SURGERY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.