NPIMap

Organization Active NPI

Bloom Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Chandler, AZ
National Provider Identifier
1578061925
Registry record updated Jan 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D009485 Issued in AZ
Legal business name
BLOOM PEDIATRIC DENTISTRY, PLLC
Practice address
1900 W Germann Rd Ste 3
Chandler, AZ 85286-6838
Phone
(480) 867-7355
Fax
(480) 907-1888
NPI assigned
Jan 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2018

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

Authorized official

Name
Dr. Janelle Unhae Lee, DDS, MSDNPI 1124275326
Title
Pediatric Dentist/ Owner
Phone
(480) 867-7355

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: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D009485 AZ Primary

Addresses

Primary practice location

1900 W Germann Rd Ste 3
Chandler, AZ 85286-6838

Mailing address

1900 W Germann Rd Ste 3
Chandler, AZ 85286-6838
Phone (480) 867-7355

Other identifiers 1

IdentifierTypeStateIssuer
154524MedicaidAZ

Other names 1

  • Bloom Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1900 W Germann Rd
Ste 3
Chandler, AZ 85286
Phone (480) 867-7355

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1578061925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W GERMANN RD STE 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852866838",
            "telephone_number": "480-867-7355",
            "fax_number": "480-907-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W GERMANN RD STE 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852866838",
            "telephone_number": "480-867-7355",
            "fax_number": "480-907-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JANELLE",
        "authorized_official_middle_name": "UNHAE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST/ OWNER",
        "authorized_official_telephone_number": "480-867-7355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D009485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154524",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.