NPI 1730535774 · live from the CMS NPI Registry
1012 Group, INC
Dentist, General Practice in San Mateo, CA. National Provider Identifier 1730535774, active.
NPI record
| NPI | 1730535774 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 800 S B St, Suite #200, San Mateo, CA 94401 |
| Practice phone | 650-458-3727 |
| Enumerated | May 9, 2016 |
| Last updated | May 9, 2016 |
| Authorized official | Patti Bolander, Director Of Operations |
| Other names | Bloom Dental Group |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | 58767 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.