| Blooming Dental, Pllc | |
|
111 N Vista Ridge Blvd Ste 100 Cedar Park TX 78613-2425 | |
| (512) 250-2356 | |
| (512) 532-6516 |
| Full Name | Blooming Dental, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 111 N Vista Ridge Blvd Ste 100, Cedar Park, Texas |
| Authorized Official Name and Position | James Lee (MEMBER) |
| Authorized Official Contact | 5122502356 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blooming Dental, Pllc 111 N Vista Ridge Blvd Ste 100 Cedar Park TX 78613-2425 Ph: (512) 250-2356 | Blooming Dental, Pllc 111 N Vista Ridge Blvd Ste 100 Cedar Park TX 78613-2425 Ph: (512) 250-2356 |
| NPI Number | 1982283032 |
|---|---|
| Provider Enumeration Date | 04/06/2021 |
| Last Update Date | 04/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982283032 | NPI | - | NPPES |
| 19039 | Other | TX | TEXAS STATE BOARD LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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