Organization
SMILES IN BLOOM PEDIATRIC DENTSITRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN RYAN BLOOM DMD (OWNER)
(860) 254-5840
Entity
Organization
Contact information
Practice address
137 PROSPECT HILL RD, EAST WINDSOR, CT 06088-3602
(860) 254-5840
(860) 254-5830
Mailing address
PO BOX 806, EAST WINDSOR, CT 06088-0806
(860) 254-5840
(860) 254-5830
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
010228
CT
Other
Enumeration date
07/06/2015
Last updated
07/06/2015
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