Provider Demographics
NPI:1457484784
Name:BLOME, GREGORY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:BLOME
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 1:2710 S 70TH ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2925
Mailing Address - Country:US
Mailing Address - Phone:402-483-7000
Mailing Address - Fax:402-483-7084
Practice Address - Street 1:2710 S 70TH ST
Practice Address - Street 2:STE. 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2925
Practice Address - Country:US
Practice Address - Phone:402-483-7000
Practice Address - Fax:402-483-7084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE695481OtherUNITED CONCORDIA
NE05672NEOtherBCBS