Individual
DR. MICHAEL AARON BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9928 N GOVERNMENT WAY, HAYDEN, ID 83835-9604
(208) 772-3583
(208) 772-3224
Mailing address
9928 N GOVERNMENT WAY, HAYDEN, ID 83835-9604
(208) 772-3583
(208) 772-3224
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3394
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149088
REGENCE BLUE SHIELD
ID
01
—
6I898
BLUE CROSS
ID
Enumeration date
10/25/2006
Last updated
07/08/2007
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