NPIMap

Organization Active NPI

Smiles in Bloom Pediatric Dentsitry

  • Pediatric Dentistry
  • East Windsor, CT
National Provider Identifier
1346623600
Registry record updated Jul 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
010228 Issued in CT
Legal business name
SMILES IN BLOOM PEDIATRIC DENTSITRY
Practice address
137 Prospect Hill Rd
East Windsor, CT 06088-3602
Phone
(860) 254-5840
Fax
(860) 254-5830
NPI assigned
Jul 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Justin Ryan Bloom, DMDNPI 1235385410
Title
Owner
Phone
(860) 254-5840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 010228 CT Primary

Addresses

Primary practice location

137 Prospect Hill Rd
East Windsor, CT 06088-3602

Mailing address

PO Box 806
East Windsor, CT 06088-0806
Phone (860) 254-5840

National Provider Directory

National Provider Directory

Locations

137 Prospect Hill Rd
East Windsor, CT 06088
Phone (860) 254-5840

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436140800000",
    "number": "1346623600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 806",
            "city": "EAST WINDSOR",
            "state": "CT",
            "postal_code": "060880806",
            "telephone_number": "860-254-5840",
            "fax_number": "860-254-5830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 PROSPECT HILL RD",
            "city": "EAST WINDSOR",
            "state": "CT",
            "postal_code": "060883602",
            "telephone_number": "860-254-5840",
            "fax_number": "860-254-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES IN BLOOM PEDIATRIC DENTSITRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-06",
        "last_updated": "2015-07-06",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-254-5840",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "010228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.