| Northern Oral & Maxillofacial Surgeons, Pa | |
|
3617 W Arrowhead Rd Duluth MN 55811-4046 | |
| (218) 722-8377 | |
| (218) 722-3117 |
| Full Name | Northern Oral & Maxillofacial Surgeons, Pa |
|---|---|
| Speciality | Dentist |
| Location | 3617 W Arrowhead Rd, Duluth, Minnesota |
| Authorized Official Name and Position | Charles R Babst (PRESIDENT) |
| Authorized Official Contact | 2187228377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Oral & Maxillofacial Surgeons, Pa 3617 W Arrowhead Rd Duluth MN 55811-4046 Ph: (218) 722-8377 | Northern Oral & Maxillofacial Surgeons, Pa 3617 W Arrowhead Rd Duluth MN 55811-4046 Ph: (218) 722-8377 |
| NPI Number | 1457401820 |
|---|---|
| Provider Enumeration Date | 01/10/2007 |
| Last Update Date | 03/05/2008 |
| Medicare PECOS PAC ID | 3072535863 |
|---|---|
| Medicare Enrollment ID | O20051221000235 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457401820 | NPI | - | NPPES |
| 60360BA | Other | MN | MINNESOTA BCBS CLINIC |
| 38393400 | Other | WI | WISCONSIN MEDICAID CLINIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2467529001 (Minnesota) | Primary |
| Provider Name | Peter J Mayer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1104976570 PECOS PAC ID: 1951323732 Enrollment ID: I20051221000179 |
| Provider Name | Duncan R Puffer |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1073663449 PECOS PAC ID: 6002824463 Enrollment ID: I20100316001045 |
| Provider Name | Marty J Espe |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1760532139 PECOS PAC ID: 7911915376 Enrollment ID: I20110110000877 |
| Provider Name | Timothy Lee Morse |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1225264575 PECOS PAC ID: 0547409179 Enrollment ID: I20130612000025 |
| Provider Name | Benjamin T Heggestad |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1598146763 PECOS PAC ID: 5294047569 Enrollment ID: I20150701000801 |
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