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General NPI Number Information
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NPI Number | 1851214324
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Entity Type | Organization
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Legal Business Name | BLOOMY'S LASER DENTISTRY
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 24 KIEFER CREEK RD
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City | ELLISVILLE
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State | MO
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Zip | 63021-6013
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Country | US
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Telephone | 636-333-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 24 KIEFER CREEK RD
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City | ELLISVILLE
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State | MO
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Zip | 63021-6013
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Country | US
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Telephone | 636-333-9711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ACKEILIA HEATRICE
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Credential | DDS
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Telephone | 636-333-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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