Provider Demographics
NPI:1093936957
Name:BLOSSOM DENTAL EXCELLENCE, INC
Entity Type:Organization
Organization Name:BLOSSOM DENTAL EXCELLENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASWINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-227-4010
Mailing Address - Street 1:6134 CAMINO VERDE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1431
Mailing Address - Country:US
Mailing Address - Phone:408-227-4010
Mailing Address - Fax:408-227-4011
Practice Address - Street 1:6134 CAMINO VERDE DR
Practice Address - Street 2:SUITE E
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1431
Practice Address - Country:US
Practice Address - Phone:408-227-4010
Practice Address - Fax:408-227-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336159383OtherTYPE 1 - NPI NUMBER