Blue Diamond Family Dental Sc | |
1502 Main St Bloomer WI 54724-1686 | |
(715) 568-2363 | |
(715) 568-2373 |
Full Name | Blue Diamond Family Dental Sc |
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Speciality | Dentist |
Location | 1502 Main St, Bloomer, Wisconsin |
Authorized Official Name and Position | Connie C Parr (BUSINESS MANAGER) |
Authorized Official Contact | 7155682363 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Blue Diamond Family Dental Sc 1502 Main St Bloomer WI 54724-1686 Ph: (715) 568-2363 | Blue Diamond Family Dental Sc 1502 Main St Bloomer WI 54724-1686 Ph: (715) 568-2363 |
NPI Number | 1245433580 |
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Provider Enumeration Date | 06/06/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245433580 | NPI | - | NPPES |
38390300 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |