Individual
JUSTIN R BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
137 PROSPECT HILL RD, SUITE C, EAST WINDSOR, CT 06088-3602
(860) 254-5840
Mailing address
PO BOX 806, EAST WINDSOR, CT 06088-0806
(860) 254-5840
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
010228
CT
1223P0221X
Pediatric Dentistry
DS037518
PA
Other
Enumeration date
08/07/2008
Last updated
01/23/2012
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