Healthcare Provider Details

I. General information

NPI: 1437297348
Provider Name (Legal Business Name): BLOOMFIELD DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 FAIRFIELD HL
BLOOMFIELD KY
40008-6127
US

IV. Provider business mailing address

208 E FLAGET AVE
BARDSTOWN KY
40004-1520
US

V. Phone/Fax

Practice location:
  • Phone: 502-252-0056
  • Fax: 502-252-0058
Mailing address:
  • Phone: 502-252-0056
  • Fax: 502-252-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6805
License Number StateKY

VIII. Authorized Official

Name: DR. JOSHUA DOLPHUS BLACKMON
Title or Position: MEMBER / PARTNER
Credential: DMD
Phone: 502-348-6404