Provider Demographics
NPI:1720696644
Name:BLOEM, BRIAN CALEB
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CALEB
Last Name:BLOEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 RESERVATION DR
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-5221
Mailing Address - Country:US
Mailing Address - Phone:828-286-2962
Mailing Address - Fax:
Practice Address - Street 1:136 RESERVATION DR
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-5221
Practice Address - Country:US
Practice Address - Phone:828-286-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice