Individual
LARRY DEAN BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
131 CARMICHAEL RD STE 200, HUDSON, WI 54016-8271
(855) 527-3848
Mailing address
131 CARMICHAEL RD STE 200, HUDSON, WI 54016-8271
(855) 527-3848
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6844-15
WI
Other
Enumeration date
06/27/2012
Last updated
06/28/2012
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