Organization
BLOOM DENTAL PRACTICE PLLC
Active
Other names
South Loop Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW BLOOM DDS (OWNER)
(317) 696-9011
Entity
Organization
Contact information
Practice address
910 S MICHIGAN AVE APT 1211, CHICAGO, IL 60605-2284
(317) 696-9011
Mailing address
910 S MICHIGAN AVE APT 1211, CHICAGO, IL 60605-2284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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