1760596340 NPI number — DR. KARLA MARIE BLOOMQUIST DDS

Table of content: DR. KARLA MARIE BLOOMQUIST DDS (NPI 1760596340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760596340 NPI number — DR. KARLA MARIE BLOOMQUIST DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOOMQUIST
Provider First Name:
KARLA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLOOMQUIST
Provider Other First Name:
KARLA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760596340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 HOLLYCROFT STREET
Provider Second Line Business Mailing Address:
280 W
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-857-4114
Provider Business Mailing Address Fax Number:
253-857-4119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 HOLLYCROFT STREET
Provider Second Line Business Practice Location Address:
STE 280 W
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-857-4114
Provider Business Practice Location Address Fax Number:
253-857-4119
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00010113 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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