Larry Dean Bloom, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

6844-15 Issued in WI

Practice address

131 Carmichael Rd Ste 200
Hudson, WI 54016-8271

Phone

(855) 527-3848

NPI assigned

Jun 27, 2012

Last updated

Jun 28, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Petite Dentistry

  • Pediatric Dentistry
  • Hudson, WI
  • NPI 1467747303
  NPD (past)

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1467716167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 CARMICHAEL RD STE 200",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168271",
            "telephone_number": "855-527-3848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 CARMICHAEL RD STE 200",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168271",
            "telephone_number": "855-527-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "LARRY",
        "middle_name": "DEAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "6844-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Wisconsin, Inc. (Fresenius Medical Care Hudson)
• Teresa L Biros, MD
• Tracey Rae Bishop, LPCC
• Jessica Blackford, DNP, FNP-BC
• Jaime Lee Blechschmidt Adomaitis, DC
• Jessica Lee Boettger, PT
• Haley Lynn Bohl
• Colleen Margaret Boissonneault, COTA
• Susan Bopray
• Kaitlyn Miranda Borgerding

• Pediatric Dentistry in Hudson, WI
• Providers in Hudson, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; 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.