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General NPI Number Information
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NPI Number | 1437297348
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Entity Type | Organization
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Legal Business Name | BLOOMFIELD DENTAL CARE, PLLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 112 FAIRFIELD HL
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City | BLOOMFIELD
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State | KY
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Zip | 40008-6127
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Country | US
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Telephone | 502-252-0056
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Fax | 502-252-0058
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Provider Business Mailing Address
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Address Line | 208 E FLAGET AVE
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City | BARDSTOWN
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State | KY
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Zip | 40004-1520
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Country | US
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Telephone | 502-252-0056
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Fax | 502-252-0058
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Authorized Official
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Title or Position | MEMBER / PARTNER
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Name | DR. JOSHUA DOLPHUS BLACKMON
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Credential | DMD
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Telephone | 502-348-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6805
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License Number State | KY
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