Organization
MT CALVARY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAITLIN BLOOMER DDS (OWNER/DENTIST)
(920) 645-1219
Entity
Organization
Contact information
Practice address
100 EVERGREEN RD, MOUNT CALVARY, WI 53057-9726
(920) 753-2771
Mailing address
3500 WOODVIEW LN, SAUKVILLE, WI 53080-1400
(920) 645-1219
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/28/2020
Last updated
11/28/2020
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