Provider Demographics
NPI:1972559391
Name:BLOOM, TODD EVAN (MS, DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:EVAN
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MS, DDS
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Mailing Address - Street 1:1305 POST RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-259-2227
Mailing Address - Fax:203-259-2218
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:SUITE 303
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-259-2227
Practice Address - Fax:203-259-2218
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT92761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery