Provider Demographics
NPI:1619785870
Name:BLOOMING SMILE DENTAL PC
Entity type:Organization
Organization Name:BLOOMING SMILE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEE SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-884-8887
Mailing Address - Street 1:162 PURDY HILL RD
Mailing Address - Street 2:UNIT 2 AND 3
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 PURDY HILL RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2115
Practice Address - Country:US
Practice Address - Phone:917-603-0675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty