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General NPI Number Information
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NPI Number | 1366513194
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Entity Type | Organization
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Legal Business Name | MITCHELL J. BLOOM, D.M.D., P.C.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 880 5TH AVE SUITE 1-G
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City | NEW YORK
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State | NY
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Zip | 10021-4951
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Country | US
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Telephone | 212-327-2623
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Fax |
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Provider Business Mailing Address
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Address Line | 880 5TH AVE SUITE 1-G
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City | NEW YORK
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State | NY
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Zip | 10021-4951
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Country | US
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Telephone | 212-327-2623
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITCHELL J. BLOOM
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Credential | D.M.D.
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Telephone | 212-327-3623
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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 | 045016
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License Number State | NY
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