Organization
1012 GROUP, INC
Active
Other names
Bloom Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
PATTI BOLANDER (DIRECTOR OF OPERATIONS)
(650) 458-3727
Entity
Organization
Contact information
Practice address
800 S B ST, SUITE #200, SAN MATEO, CA 94401-4271
(650) 458-3727
Mailing address
800 S B ST, SUITE #200, SAN MATEO, CA 94401-4271
(650) 458-3727
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
58767
CA
Other
Enumeration date
05/09/2016
Last updated
05/09/2016
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