Provider Demographics
NPI:1992856728
Name:BLOOM, CASEY MCCARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MCCARY
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 EASTERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071
Mailing Address - Country:US
Mailing Address - Phone:205-631-1752
Mailing Address - Fax:
Practice Address - Street 1:704 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4221
Practice Address - Country:US
Practice Address - Phone:256-739-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5507122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist