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General NPI Number Information
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NPI Number | 1679496301
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Entity Type | Organization
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Legal Business Name | ERIC N. BLOOM, DDS, LTD
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 2300 LEHIGH AVE STE 145
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City | GLENVIEW
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State | IL
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Zip | 60026-1692
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Country | US
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Telephone | 847-998-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 LEHIGH AVE STE 145
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City | GLENVIEW
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State | IL
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Zip | 60026-1692
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Country | US
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Telephone | 847-998-0155
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | CHRISTY DUPIN
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Credential |
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Telephone | 480-674-4151
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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 |
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License Number State |
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