Healthcare Provider Details

I. General information

NPI: 1982819462
Provider Name (Legal Business Name): TOM E BLUE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42500 BOB HOPE
RANCH MIRAGE CA
92270
US

IV. Provider business mailing address

42500 BOB HOPE DR
RANCHO MIRAGE CA
92270-4471
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-2797
  • Fax:
Mailing address:
  • Phone: 760-568-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number32275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: