NPI 1093884462

Jonathan a Bloom, DDS

Practitioner General Practice Dentistry South Burlington, VT

Practice location

Address: 118 Tilley Dr STE 101, South Burlington, VT 05403-4450
Phone: (802) 863-3950
Fax: (802) 863-3601
Mailing address: 120 Nicklaus Cir, South Burlington, VT 05403-8015

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 2268 (VT)

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Registry record

NPI: 1093884462
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Nov 2006
Record last updated: 16 May 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.