Healthcare Provider Details

I. General information

NPI: 1679496301
Provider Name (Legal Business Name): ERIC N. BLOOM, DDS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 LEHIGH AVE STE 145
GLENVIEW IL
60026-1692
US

IV. Provider business mailing address

2300 LEHIGH AVE STE 145
GLENVIEW IL
60026-1692
US

V. Phone/Fax

Practice location:
  • Phone: 847-998-0155
  • Fax:
Mailing address:
  • Phone: 847-998-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY DUPIN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-674-4151