Individual
KIANNA BLOOMFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3840 LAVISTA RD, TUCKER, GA 30084-5142
(678) 904-6685
Mailing address
1911 SW 95TH TER, MIRAMAR, FL 33025-1960
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN123185
GA
122300000X
Dentist
DN28367
FL
Other
Enumeration date
05/08/2023
Last updated
08/31/2023
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