# 1012 GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bloom Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730535774
- **Authorized official:** PATTI BOLANDER (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (650) 458-3727

## Contact information

- **Practice address:** 800 S B ST, SUITE \#200, SAN MATEO, CA 94401-4271
- **Practice address phone:** (650) 458-3727
- **Mailing address:** 800 S B ST, SUITE \#200, SAN MATEO, CA 94401-4271
- **Mailing address phone:** (650) 458-3727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 58767 | CA | Yes |

## Other

- **Enumeration date:** 05/09/2016
- **Last updated:** 05/09/2016