Provider Demographics
NPI:1669698932
Name:BLOM, HENRY A (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:BLOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CROWS NEST RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4816
Mailing Address - Country:US
Mailing Address - Phone:914-337-1157
Mailing Address - Fax:914-337-1165
Practice Address - Street 1:10 STUDIO ARC
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2631
Practice Address - Country:US
Practice Address - Phone:914-337-1157
Practice Address - Fax:914-337-1165
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0384621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice