| NPI | 1265007629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES H BLOOM Dentist Owner 908-720-5621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-05-26 |