Provider Demographics
NPI:1649528027
Name:CRAIG Y. BLOOM,DMD,RICHARD M.A. BERGER, DDS, BRYAN R. KREY, DMD,APC &
Entity type:Organization
Organization Name:CRAIG Y. BLOOM,DMD,RICHARD M.A. BERGER, DDS, BRYAN R. KREY, DMD,APC &
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-848-1055
Mailing Address - Street 1:2522 DANA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2895
Mailing Address - Country:US
Mailing Address - Phone:510-848-1055
Mailing Address - Fax:510-848-9100
Practice Address - Street 1:2522 DANA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2895
Practice Address - Country:US
Practice Address - Phone:510-848-1055
Practice Address - Fax:510-848-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty