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1012 Group, Inc — NPI 1730535774, San Mateo, CA | NPI Central

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NPI 1730535774

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1012 Group, Inc

NPI 1730535774 · General Practice Dentistry · San Mateo, CA

Provider details

NPI number: 1730535774
Entity type: Organization
Primary specialty: General Practice DentistryDental Providers
Organization subpart: No
Authorized official: Patti Bolander, Director of Operations(650) 458-3727
License: 58767 (CA)

Specialties & taxonomies

General Practice DentistryPrimary1223G0001XLicense 58767 (CA)
Dental Providers

Practice location

800 S B St

Suite #200

San Mateo, CA 94401-4271

Phone: (650) 458-3727

Approximate (ZIP-level) locationGet directions

More CA providers

Mailing address

800 S B St

San Mateo, CA 94401-4271

Other names (DBA / former)

Doing business as: Bloom Dental Group

Registry dates

Enumerated: 2016-05-09
Last updated: 2016-05-09

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.