Provider Demographics
NPI:1194057174
Name:CRAIG Y. BLOOM,DMD, RICHARD M.A. BERGER,DDS & BRYAN R. KREY, DMD, APC
Entity type:Organization
Organization Name:CRAIG Y. BLOOM,DMD, RICHARD M.A. BERGER,DDS & BRYAN R. KREY, DMD, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:YALE
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-848-1055
Mailing Address - Street 1:2522 DANA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2895
Mailing Address - Country:US
Mailing Address - Phone:510-848-1055
Mailing Address - Fax:510-848-1055
Practice Address - Street 1:2522 DANA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2895
Practice Address - Country:US
Practice Address - Phone:510-848-1055
Practice Address - Fax:510-848-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty