| Doctor Name: | JUSTIN R BLOOM |
| NPI Number: | 1235385410 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMD |
| License Number: | DS037518 |
| Business Practice Address: | 137 Prospect Hill Rd Suite C East Windsor, CT - 060883602 |
| Business Phone Number: | 8602545840 |
| Business Fax Number: | |
| Mailing Address: | Po Box 806, EAST WINDSOR |
| State: | CT |
| Postal Code: | 060880806 |
| Phone Number: | 8602545840 |
| Fax Number: | |
| NPI Enumeration Date: | 08/07/2008 |
| NPI Last Update Date: | 01/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | DS037518 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |