Provider Demographics
NPI:1265645576
Name:BLOOM, JAY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROBERT
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2885
Mailing Address - Country:US
Mailing Address - Phone:732-892-6666
Mailing Address - Fax:
Practice Address - Street 1:3156 ROUTE 88
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2885
Practice Address - Country:US
Practice Address - Phone:732-892-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ145531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics