MEDICARE: ASPEN BLOOM, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1578407607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN BLOOM, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 70887
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44190-0887
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:	315-410-5531

Provider Business Practice Location Address
First Line	:	7936 PORTLAND AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-1315
Country	:	US
Telephone Number	:	952-852-7776
Fax Number	:	952-703-0458

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT MANAGER
Name	:	CHRISTINE BARBER
Credential	:
Telephone Number	:	315-454-6000

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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Directions to “ASPEN BLOOM, PLLC ” Practice Location

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