100 SOUTH BLOOMFIELD PROFESSIONAL, LLC (NPI# 1912519067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912519067 |
| Entity Type | Organization |
| Organization Name | 100 SOUTH BLOOMFIELD PROFESSIONAL, LLC |
| Practice Address |
100 S 1st St Bloomfield NM 87413-6242 |
| Practice Telephone | 5056323344 |
| Mailing Telephone | 5056323344 |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-08-20 |
| Authorized Official Name | PETER GRUMBOS (OWNER) |
| Authorized Official Telephone | 5056323344 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Sundance Dental Care of Bloomfield | Doing Business As Name - Organization |
| Street Address |
100 S 1ST ST |
| City | BLOOMFIELD |
| State | NM |
| Zip Code | 87413-6242 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700429446 | Jordan Chase Morris | Dentist | 100 S 1st St, Bloomfield, NM 87413-6242 | 2019-10-25 |
| 1639532286 | Lauren Fangman Schau | Dentist | 100 S 1st St, Bloomfield, NM 87413-6242 | 2016-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396057 | Heather Smith | Behavior Technician | 25a Cr 5060, Bloomfield, NM 87413 | 2020-11-04 |
| 1104292325 | Michelle Childers-beck | Social Worker | 235 N Bergin Lane, Bloomfield, NM 87413 | 2015-08-12 |
| 1427364090 | Marichu Lazo | Occupational Therapy Assistant | 803 Hacienda Lane, Bloomfield, NM 87413 | 2010-08-20 |
| 1023344181 | Sundance Dental Care of Bloomfield, LLC. | Dentist | 100 South First Street, Bloomfield, NM 87413 | 2009-10-26 |
| 1972838266 | Chris Dwight Richardson | Physical Therapy Assistant | #6 Cty Rd 5149, Bloomfield, NM 87413 | 2009-10-05 |
| 1710025028 | Roy Hernandez | Speech-Language Pathologist | 325 North Bergin Lane, Bloomfield, NM 87413 | 2007-02-01 |
| 1760427587 | Dhhs, Phs, Naihs, Shiprock Hospital | Clinic/Center | 6 Road 7586, Bloomfield, NM 87413 | 2006-06-17 |
| 1568500833 | Connie Hernandez | Speech-Language Pathologist | 325 North Bergin Lane, Bloomfield, NM 87413-2430 | 2007-02-01 |
| 1841453636 | James Bellah | Family Medicine | 6 County Road 7586, Bloomfield, NM 87413-4934 | 2008-07-02 |
| 1598751778 | David Lynn Doss | Optometrist | 6 Road 7586, Bloomfield, NM 87413-4934 | 2005-09-23 |
| Find all providers in zip 87413 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023500030 | Jeffrey D Haimson Dmd | Dentist | 1018 Broad St Ste 4, Bloomfield, NJ 07003-2884 | 2018-06-05 |
| 1134648660 | Kushan K Shah | Dentist | 2 Wintonbury Mall Ste 5, Bloomfield, CT 06002-2466 | 2017-09-15 |
| 1245583798 | Bloomfield Family Dental, PC | Dentist | 2 Wintonbury Mall # 5, Bloomfield, CT 06002-2466 | 2012-10-22 |
| 1023344181 | Sundance Dental Care of Bloomfield, LLC. | Dentist | 100 South First Street, Bloomfield, NM 87413 | 2009-10-26 |
| 1861648768 | Qiaomei Yan | Dentist | 800 Cottage Grove Rd # Set311, Bloomfield, CT 06002-3064 | 2008-08-11 |
| 1467626721 | Anthony V. Parrillo | Dentist | 171 Willard Ave, Bloomfield, NJ 07003-4800 | 2008-04-17 |
| 1457547937 | Elizabeth Sandoval | Dentist | 1025 Broad St Ste 3, Bloomfield, NJ 07003-2844 | 2007-09-19 |
| 1548463680 | Anthony Gerard Devincentis | Dentist | 1218 Broad St, Bloomfield, NJ 07003-3031 | 2007-06-07 |
| 1578684742 | Robert Lewis Adams | Dentist | 12 Carnoustie Cir., Bloomfield, CT 06002 | 2007-04-03 |
| 1720130024 | Lori A Haines | Dentist | 112 Fairfield Hill, Bloomfield, KY 40008 | 2007-01-17 |
| Find all providers in BLOOMFIELD | ||||
| City | BLOOMFIELD |
| Zip Code | 87413 |
Please comment or provide details below to improve the information on 100 SOUTH BLOOMFIELD PROFESSIONAL, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.