Provider Demographics
NPI:1760596340
Name:BLOOMQUIST, KARLA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:MARIE
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KARLA
Other - Middle Name:MARIE
Other - Last Name:BLOOMQUIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2727 HOLLYCROFT STREET
Mailing Address - Street 2:280 W
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-857-4114
Mailing Address - Fax:253-857-4119
Practice Address - Street 1:2727 HOLLYCROFT STREET
Practice Address - Street 2:STE 280 W
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-857-4114
Practice Address - Fax:253-857-4119
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist