Provider Demographics
NPI:1881795995
Name:BLOOM, ERIC N (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:N
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LEHIGH AVE
Mailing Address - Street 2:SUITE #145
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1691
Mailing Address - Country:US
Mailing Address - Phone:847-998-0155
Mailing Address - Fax:847-998-9125
Practice Address - Street 1:2300 LEHIGH AVE
Practice Address - Street 2:SUITE #145
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1691
Practice Address - Country:US
Practice Address - Phone:847-998-0155
Practice Address - Fax:847-998-9125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice