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Organization
BLUE LAKE SMILES
Active
Organization
BLUE LAKE SMILES
Active
Other names
Blue Lake Smiles Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
GAURAV JAIN DDS (PEDIATRIC DENTIST)
(612) 308-2244
Entity
Organization
Contact information
Practice address
845 S MAIN ST STE 130, FOND DU LAC, WI 54935-6116
(920) 581-8505
Mailing address
10749 N TREE SPARROW DR, MEQUON, WI 53097
(612) 308-2244
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
NULL
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/25/2025
Last updated
11/25/2025
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