Provider Demographics
NPI:1053589978
Name:BLOOMER, ANDERSAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDERSAN
Middle Name:M
Last Name:BLOOMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4088
Mailing Address - Country:US
Mailing Address - Phone:410-663-1073
Mailing Address - Fax:410-663-1072
Practice Address - Street 1:7636 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-663-1073
Practice Address - Fax:410-663-1072
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice