Bloom Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BLOOM DENTAL, LLC

Doing business as

Crystal Dentistry

Practice address

3970 FM 2181 Ste 200
Hickory Creek, TX 75065-4249

Phone

(940) 600-5365

NPI assigned

Sep 1, 2023

Organization subpart

No

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

Authorized official

Name

Alyaa K Mafrag, DMDNPI 1134883127

Title

Owner

Phone

(210) 803-8889

Specialties & licenses 1

Addresses

Other names 1

• Crystal Dentistry Doing business as

Locations

Practitioners 1

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.

• Alyaa Mafrag, DMD

  • Dentist
  • Prosper, TX
  • NPI 1134883127
  NPD Authorized official

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

{
    "created_epoch": "1693526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1770369092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 FM 2181 STE 200",
            "city": "HICKORY CREEK",
            "state": "TX",
            "postal_code": "750654249",
            "telephone_number": "940-600-5365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 FM 2181 STE 200",
            "city": "HICKORY CREEK",
            "state": "TX",
            "postal_code": "750654249",
            "telephone_number": "940-600-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-01",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "MAFRAG",
        "authorized_official_first_name": "ALYAA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-803-8889",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crystal Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Hickory Creek, TX
• Providers in Hickory Creek, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.