Organization
LARRY D. BLOOM, DDS, PA
Active
Other names
Cochise Children's Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY DEAN BLOOM DDS (PRESIDENT)
(520) 458-1835
Entity
Organization
Contact information
Practice address
2273 E WILCOX DR, SIERRA VISTA, AZ 85635-2755
(520) 458-1835
(520) 459-4145
Mailing address
2273 E WILCOX DR, SIERRA VISTA, AZ 85635-2755
(520) 458-1835
(520) 459-4145
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3807
AZ
Other
Enumeration date
11/10/2006
Last updated
03/21/2008
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