Provider Demographics
NPI:1891965265
Name:BLOOM, HELEN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:MARIE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HELEN MARIE
Other - Middle Name:BLOOM
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1120 BEACON PKWY E APT 307
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1023
Mailing Address - Country:US
Mailing Address - Phone:205-835-8181
Mailing Address - Fax:
Practice Address - Street 1:1120 BEACON PKWY E APT 307
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1023
Practice Address - Country:US
Practice Address - Phone:205-835-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist