| Blue Water Oral And Facial Surgery | |
|
303 Se 1st St Grand Rapids MN 55744-3681 | |
| (218) 326-0349 | |
| (218) 326-5005 |
| Full Name | Blue Water Oral And Facial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 303 Se 1st St, Grand Rapids, Minnesota |
| Authorized Official Name and Position | Katherine Anne Lafleur (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 2187221854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Water Oral And Facial Surgery 303 Se 1st St Grand Rapids MN 55744-3681 Ph: (218) 326-0349 | Blue Water Oral And Facial Surgery 303 Se 1st St Grand Rapids MN 55744-3681 Ph: (218) 326-0349 |
| NPI Number | 1679668529 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 09/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679668529 | NPI | - | NPPES |
| 861461000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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