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| Company Name: | DELTA DENTAL INSURANCE COMPANY |
| Employer identification number (EIN): | 810520992 |
| National Association of Insurance Commissioner's ID: | 00000 |
| NAIC Classification: | 00000 |
| MT BLOOM HOLDINGS, LLC | MT BLOOM HOLDINGS, LLC HEALTH & WELFARE BENEFIT PLAN | 2022-09-01 |
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