Provider Demographics
NPI:1821143520
Name:BLOOMFIELD DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:BLOOMFIELD DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:GOLDSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-338-3550
Mailing Address - Street 1:43380 WOODWARD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43380 WOODWARD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5050
Practice Address - Country:US
Practice Address - Phone:248-338-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty