Craig Yale Bloom, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

31571 Issued in CA

Practice address

2522 Dana St
Suite 202
Berkeley, CA 94704-2803

Phone

(510) 848-1055

Fax

(510) 848-9100

NPI assigned

Jan 22, 2007

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)

Enrolled

State licenses

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841344751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2522 DANA ST",
            "address_2": "SUITE 202",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042803",
            "telephone_number": "510-848-1055",
            "fax_number": "510-848-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2522 DANA ST",
            "address_2": "SUITE 202",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042803",
            "telephone_number": "510-848-1055",
            "fax_number": "510-848-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "CRAIG",
        "middle_name": "YALE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "31571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blen LLC
• Keith Bless
• Lucy Anne Blevins
• Anika Blitzstein
• Donald A Block, MD
• Iris Miriam Bloomfield
• Scott Blossom, L.AC.
• Christopher Alan Blubaugh, RN
• Blue Sky Hearing & Audiology, Inc.
• Sasha Blum, PH.D.

• Oral and Maxillofacial Surgery (Dentist) in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.