Provider Demographics
NPI:1447374939
Name:DM BLOORE D.D.S APC
Entity type:Organization
Organization Name:DM BLOORE D.D.S APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-385-1999
Mailing Address - Street 1:14256 VENTURA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2754
Mailing Address - Country:US
Mailing Address - Phone:818-385-1999
Mailing Address - Fax:818-385-1988
Practice Address - Street 1:14256 VENTURA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2754
Practice Address - Country:US
Practice Address - Phone:818-385-1999
Practice Address - Fax:818-385-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty