| South Central Oral & Maxillofacial Surgery, Llc | |
|
2911 E Covenanter Dr Suite B Bloomington IN 47401-6320 | |
| (812) 333-2614 | |
| (812) 333-4594 |
| Full Name | South Central Oral & Maxillofacial Surgery, Llc |
|---|---|
| Speciality | Dentist |
| Location | 2911 E Covenanter Dr, Bloomington, Indiana |
| Authorized Official Name and Position | Timothy A Pliske (OWNER) |
| Authorized Official Contact | 8123332614 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Central Oral & Maxillofacial Surgery, Llc 2911 E Covenanter Dr Suite B Bloomington IN 47401-6320 Ph: (812) 333-2614 | South Central Oral & Maxillofacial Surgery, Llc 2911 E Covenanter Dr Suite B Bloomington IN 47401-6320 Ph: (812) 333-2614 |
| NPI Number | 1760461339 |
|---|---|
| Provider Enumeration Date | 01/12/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3072796333 |
|---|---|
| Medicare Enrollment ID | O20110323000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760461339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12008000/12009582 (Indiana) | Primary |
| Provider Name | Timothy Alan Pliske |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1134206618 PECOS PAC ID: 0143403402 Enrollment ID: I20110629000689 |
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