| Great Blue Dental, Llc | |
|
2005 Marinette Ave Marinette WI 54143-3864 | |
| (715) 732-2601 | |
| Not Available |
| Full Name | Great Blue Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2005 Marinette Ave, Marinette, Wisconsin |
| Authorized Official Name and Position | Wyn Steckbauer (OWNER) |
| Authorized Official Contact | 9202353251 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Blue Dental, Llc 2005 Marinette Ave Marinette WI 54143-3864 Ph: () - | Great Blue Dental, Llc 2005 Marinette Ave Marinette WI 54143-3864 Ph: (715) 732-2601 |
| NPI Number | 1720534159 |
|---|---|
| Provider Enumeration Date | 08/26/2016 |
| Last Update Date | 08/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720534159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5396-15 (Wisconsin) | Primary |
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