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General NPI Number Information
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NPI Number | 1396653143
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Entity Type | Organization
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Legal Business Name | BLOOM DENTAL - BEDFORD, LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 1504 DENTAL DR
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City | BEDFORD
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State | IN
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Zip | 47421-3574
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Country | US
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Telephone | 812-275-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 435 VIRGINIA AVE UNIT 1900
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-1964
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RCM
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Name | HALEY LONG
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Credential |
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Telephone | 317-313-8457
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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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