Provider Demographics
NPI:1528185477
Name:BLOOMFIELD, GARY BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRIAN
Last Name:BLOOMFIELD
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 1:2301 S HURON PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5133
Mailing Address - Country:US
Mailing Address - Phone:734-971-2310
Mailing Address - Fax:734-971-1120
Practice Address - Street 1:2301 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5133
Practice Address - Country:US
Practice Address - Phone:734-971-2310
Practice Address - Fax:734-971-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010120071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice