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Organization

MICHAEL A. BLOOM D.M.D. PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KATHY L. MARKS (OFFICE MANAGER)
(208) 772-3583
Entity
Organization

Contact information

Practice address
9928 N GOVERNMENT WAY, HAYDEN LAKE, ID 83835-9604
(208) 772-3583
(208) 772-3224
Mailing address
PO BOX 425, HAYDEN LAKE, ID 83835-0425
(208) 772-3583
(208) 772-3224

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
D3394
ID
302R00000X
Health Maintenance Organization
D3555
ID

Other

Enumeration date
05/07/2013
Last updated
05/07/2013
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