1012 Group, Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

58767 Issued in CA

Legal business name

1012 GROUP, INC

Doing business as

Bloom Dental Group

Practice address

800 S B St
Suite #200
San Mateo, CA 94401-4271

Phone

(650) 458-3727

NPI assigned

May 9, 2016

Last updated

May 9, 2016By 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

Patti Bolander

Title

Director of Operations

Phone

(650) 458-3727

Specialties & licenses 1

Addresses

Other names 1

• Bloom Dental Group Doing business as

Locations

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462752000000",
    "number": "1730535774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S B ST",
            "address_2": "SUITE #200",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944014271",
            "telephone_number": "650-458-3727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S B ST",
            "address_2": "SUITE #200",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944014271",
            "telephone_number": "650-458-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1012 GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-05-09",
        "status": "A",
        "authorized_official_last_name": "BOLANDER",
        "authorized_official_first_name": "PATTI",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "650-458-3727"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in San Mateo, CA
• Providers in San Mateo, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; 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.