Provider Demographics
NPI:1679628960
Name:BLOEM, THOMAS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BLOEM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:BLOEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:5340 PLYMOUTH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9341
Mailing Address - Country:US
Mailing Address - Phone:734-995-4699
Mailing Address - Fax:734-995-9685
Practice Address - Street 1:5340 PLYMOUTH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-995-4699
Practice Address - Fax:734-995-9685
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112681223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics