# CHARLES H BLOOM, DMD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265007629
- **Authorized official:** DR. CHARLES H BLOOM DMD (DENTIST OWNER)
- **Authorized official phone:** (908) 720-5621

## Contact information

- **Practice address:** 815 LIVINGSTON AVE, NEW BRUNSWICK, NJ 08901-3344
- **Practice address phone:** (732) 249-6386
- **Mailing address:** 815 LIVINGSTON AVE, NEW BRUNSWICK, NJ 08901-3344
- **Mailing address phone:** (732) 249-6386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 05/26/2021
- **Last updated:** 05/26/2021