Larry D. Bloom, DDS, PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D3807 Issued in AZ

Legal business name

LARRY D. BLOOM, DDS, PA

Doing business as

Cochise Children's Dental Center

Practice address

2273 E Wilcox Dr
Sierra Vista, AZ 85635-2755

Phone

(520) 458-1835

Fax

(520) 459-4145

NPI assigned

Nov 10, 2006

Last updated

Mar 21, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Larry Dean Bloom, DDS

Title

President

Phone

(520) 458-1835

Specialties & licenses 1

Addresses

Other names 1

• Cochise Children's Dental Center Doing business as

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206057600000",
    "number": "1457422669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2273 E WILCOX DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352755",
            "telephone_number": "520-458-1835",
            "fax_number": "520-459-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2273 E WILCOX DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352755",
            "telephone_number": "520-458-1835",
            "fax_number": "520-459-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY D. BLOOM, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2008-03-21",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-458-1835",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D3807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cochise Children's Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Dentistry in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2008; 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.