| Blue Water Oral And Facial Surgery | |
|
3712 Tower Ave Suite E Superior WI 54880-5567 | |
| (715) 392-9846 | |
| (715) 392-7040 |
| Full Name | Blue Water Oral And Facial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 3712 Tower Ave, Superior, Wisconsin |
| Authorized Official Name and Position | Katherine Anne Lafleur (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 2187221854 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Water Oral And Facial Surgery 3712 Tower Ave Suite E Superior WI 54880-5567 Ph: (715) 392-9846 | Blue Water Oral And Facial Surgery 3712 Tower Ave Suite E Superior WI 54880-5567 Ph: (715) 392-9846 |
| NPI Number | 1003900994 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 09/30/2024 |
| Medicare PECOS PAC ID | 4880779321 |
|---|---|
| Medicare Enrollment ID | O20080308000053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003900994 | NPI | - | NPPES |
| 000078627 | Other | MEDICARE CLINIC | |
| 987507700 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Scott K Varland |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255505996 PECOS PAC ID: 9032278205 Enrollment ID: I20090218000308 |
| Provider Name | Paul K Hodapp |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750475299 PECOS PAC ID: 0244315786 Enrollment ID: I20090309000150 |
| Provider Name | Eric B Scotland |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1679793244 PECOS PAC ID: 8729256060 Enrollment ID: I20221027000155 |
Northern Oral & Maxillofacial Surgeons, Pa Dental Clinic Medicare: Medicare Enrolled Practice Location: 503 Belknap St, Superior, WI 54880 Phone: 715-564-4081 Fax: 715-564-4083 | |
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Lifetime Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1507 Tower Ave Ste 202, Superior, WI 54880 Phone: 715-394-3683 Fax: 715-394-7315 | |
Conkright Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 823 Belknap St, Suite 220, Superior, WI 54880 Phone: 715-932-4545 Fax: 715-392-4547 | |
Nbo Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1507 Tower Ave Ste 410, Superior, WI 54880 Phone: 715-392-6213 |