# BLUE WATER DENTAL GROUP MARYSVILLE PC

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

## Provider details

- **NPI number:** 1508975319
- **Authorized official:** DR. WILLIAM LEE KILE DDS FICCMO (PRESIDENT)
- **Authorized official phone:** (810) 364-7601

## Contact information

- **Practice address:** 1616 GRATIOT BLVD, MARYVILLE, MI 48040-1181
- **Practice address phone:** (810) 364-7601
- **Practice address fax:** (810) 364-9010
- **Mailing address:** 1616 GRATIOT BLVD, MARYVILLE, MI 48040-1181
- **Mailing address phone:** (810) 364-7601
- **Mailing address fax:** (810) 364-9010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2901008847 | MI | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 08/22/2020