Organization
ORTHOGENESIS, LLC
Active
Other names
Bloom Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA BULLOCK (PRACTICE MANAGER)
(770) 680-2335
Entity
Organization
Contact information
Practice address
3005 ROYAL BLVD S, SUITE 200, ALPHARETTA, GA 30022-1409
(770) 680-2335
(678) 550-3046
Mailing address
3005 ROYAL BLVD S, SUITE 200, ALPHARETTA, GA 30022-1409
(770) 680-2335
(678) 550-3046
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/29/2014
Last updated
12/29/2014
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