# BLUE WATER FAMILY DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396756615
- **Authorized official:** DR. WILLIAM SCOTT MEYER DDS (DENTIST)
- **Authorized official phone:** (810) 385-2273

## Contact information

- **Practice address:** 4044 24TH AVE, FORT GRATIOT, MI 48059
- **Practice address phone:** (810) 385-2273
- **Practice address fax:** (810) 385-6285
- **Mailing address:** 4044 24TH AVE, FORT GRATIOT, MI 48059
- **Mailing address phone:** (810) 385-2273
- **Mailing address fax:** (810) 385-6285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 15282 | MI | — |
| 122300000X | Dentist | 16113 | MI | — |
| 122300000X | Dentist | 16735 | MI | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 08/22/2020