Provider Demographics
NPI:1528666773
Name:BLOOM, KRISTIN ANNE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 CANVASBACK LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-8457
Mailing Address - Country:US
Mailing Address - Phone:775-229-6467
Mailing Address - Fax:
Practice Address - Street 1:290 BRINKBY AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4348
Practice Address - Country:US
Practice Address - Phone:775-825-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant