Provider Demographics
NPI:1245106194
Name:EMERGENCY DENTAL BLOOMINGTON LLC
Entity type:Organization
Organization Name:EMERGENCY DENTAL BLOOMINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-498-0420
Mailing Address - Street 1:6030 WOODBRUSH WAY
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-8027
Mailing Address - Country:US
Mailing Address - Phone:317-498-0420
Mailing Address - Fax:
Practice Address - Street 1:3800 W INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5139
Practice Address - Country:US
Practice Address - Phone:317-498-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental