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General NPI Number Information
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NPI Number | 1245106194
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Entity Type | Organization
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Legal Business Name | EMERGENCY DENTAL BLOOMINGTON LLC
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Dates
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Enumeration Date | 10/16/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 3800 W INDUSTRIAL BLVD
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5139
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Country | US
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Telephone | 317-498-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 6030 WOODBRUSH WAY
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-8027
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Country | US
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Telephone | 317-498-0420
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ROBERT STRATMAN
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Credential | DDS
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Telephone | 317-498-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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