Individual
DR. JONATHAN A BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
118 TILLEY DR STE 101, SOUTH BURLINGTON, VT 05403-4450
(802) 863-3950
(802) 863-3601
Mailing address
120 NICKLAUS CIR, SOUTH BURLINGTON, VT 05403-8015
(802) 497-0814
(802) 497-0814
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2268
VT
Other
Enumeration date
11/07/2006
Last updated
05/16/2012
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