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General NPI Number Information
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NPI Number | 1417483876
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Entity Type | Individual
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Provider Name | ANDREW BLOOM DDS
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Gender | Male
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 200 MEDICAL DR STE A
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City | CARMEL
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State | IN
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Zip | 46032-2985
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Country | US
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Telephone | 317-575-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 12026 WOODS BAY CT
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City | CARMEL
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State | IN
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Zip | 46033-9524
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12012763A
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License Number State | IN
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