Provider Demographics
NPI:1336293091
Name:BLOOMER, CHARLES R (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BLOOMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5200 BUFFALO GAP RD STE B
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-4151
Mailing Address - Country:US
Mailing Address - Phone:325-691-1140
Mailing Address - Fax:325-691-1141
Practice Address - Street 1:5200 BUFFALO GAP RD STE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-4151
Practice Address - Country:US
Practice Address - Phone:325-691-1140
Practice Address - Fax:325-691-1141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX124131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery