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General NPI Number Information
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NPI Number | 1265007629
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Entity Type | Organization
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Legal Business Name | CHARLES H BLOOM, DMD
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 815 LIVINGSTON AVE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-3344
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Country | US
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Telephone | 732-249-6386
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Fax |
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Provider Business Mailing Address
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Address Line | 815 LIVINGSTON AVE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-3344
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Country | US
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Telephone | 732-249-6386
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. CHARLES H BLOOM
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Credential | DMD
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Telephone | 908-720-5621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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