Provider Demographics
NPI:1548935463
Name:JAMES BLOOM DDS PLLC
Entity type:Organization
Organization Name:JAMES BLOOM DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-804-1967
Mailing Address - Street 1:5208 FOX MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8976
Mailing Address - Country:US
Mailing Address - Phone:443-804-1967
Mailing Address - Fax:
Practice Address - Street 1:11949 LIONESS WAY STE 100
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-6083
Practice Address - Country:US
Practice Address - Phone:443-804-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental