MICHAEL A. BLOOM D.M.D. PLLC

HAYDEN LAKE, ID
NPI1033554845
Entity TypeOrganization
Authorized ContactKATHY L. MARKS
Office Manager
208-772-3583
Organization Subpart ?No
Primary Taxonomy302R00000X Health Maintenance Organization
(Licence: ID  D3394)
Additional Taxonomies302R00000X Health Maintenance Organization
(Licence: ID  D3555)
Enumeration Date2013-05-07
Last Update Date2013-05-07
Business Address
MICHAEL A. BLOOM D.M.D. PLLC
9928 N GOVERNMENT WAY
HAYDEN LAKE, ID 83835-9604
Phone number: 208-772-3583
Mailing Address
MICHAEL A. BLOOM D.M.D. PLLC
PO BOX 425
HAYDEN LAKE, ID 83835-0425
Phone number: 208-772-3583