| Bluestone Oral And Maxillofacial Surgery, P.a. | |
|
1616 Cloquet Ave Cloquet MN 55720-1948 | |
| (218) 879-3761 | |
| (218) 879-6057 |
| Full Name | Bluestone Oral And Maxillofacial Surgery, P.a. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1616 Cloquet Ave, Cloquet, Minnesota |
| Authorized Official Name and Position | Jean Diane Southworth (BUSINESS MANAGAER) |
| Authorized Official Contact | 2187278994 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluestone Oral And Maxillofacial Surgery, P.a. 324 W Superior St Suite 720 Duluth MN 55802-1701 Ph: (218) 727-8994 | Bluestone Oral And Maxillofacial Surgery, P.a. 1616 Cloquet Ave Cloquet MN 55720-1948 Ph: (218) 879-3761 |
| NPI Number | 1326290727 |
|---|---|
| Provider Enumeration Date | 10/16/2008 |
| Last Update Date | 10/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326290727 | NPI | - | NPPES |
| 166644400 | Medicaid | MN | |
| DB2954 | Other | MN | RAILROAD MEDICAL GROUP# |
| 01630538 | Other | MN | UNITED CONCORDIA (CLOUQET) |
| U12947 | Other | MN | UPIN# |
| 01630541 | Other | UNITED CONCORDIA (DULUTH) | |
| 6B297JE | Other | MN | BLUE CROSS/BLUE SHIELD MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (Minnesota) | Primary |
Fond Du Lac Human Services Division Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 927 Trettel Lane, Fond Du Lac Human Services Division Dental Clinic, Cloquet, MN 55720 Phone: 218-879-1227 Fax: 218-878-3755 | |
North Country Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 716 14th St, Cloquet, MN 55720 Phone: 218-879-5271 Fax: 218-878-7990 |