Organization
BLOOMING DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES LEE DDS (MEMBER)
(512) 250-2356
Entity
Organization
Contact information
Practice address
111 N VISTA RIDGE BLVD STE 100, CEDAR PARK, TX 78613-2425
(512) 250-2356
(512) 532-6516
Mailing address
111 N VISTA RIDGE BLVD STE 100, CEDAR PARK, TX 78613-2425
(512) 250-2356
(512) 532-6516
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19039
TEXAS STATE BOARD LICENSE
TX
Enumeration date
04/06/2021
Last updated
04/06/2021
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