Individual
DR. NATHAN LEE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3233 SUPERIOR AVE, SHEBOYGAN, WI 53081-1858
(920) 457-0888
(920) 457-0896
Mailing address
3233 SUPERIOR AVE, SHEBOYGAN, WI 53081-1858
(920) 457-0888
(920) 457-0896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6711-015
WI
Other
Enumeration date
07/03/2011
Last updated
05/11/2015
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