Provider Demographics
NPI:1659582419
Name:BLOOM, DAVID I JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:BLOOM
Suffix:JR
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 1:1060 DAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-5719
Mailing Address - Country:US
Mailing Address - Phone:860-688-5595
Mailing Address - Fax:860-688-7403
Practice Address - Street 1:1060 DAY HILL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-5719
Practice Address - Country:US
Practice Address - Phone:860-688-5595
Practice Address - Fax:860-688-7403
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice