# BLUE WATER DENTAL GROUP PORT HURON P.C.

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

## Provider details

- **NPI number:** 1669649026
- **Authorized official:** LUANN THOMPSON (OFFICE MANAGER)
- **Authorized official phone:** (810) 987-7224

## Contact information

- **Practice address:** 803 SUPERIOR ST, PORT HURON, MI 48060-3764
- **Practice address phone:** (810) 987-7224
- **Practice address fax:** (810) 987-8585
- **Mailing address:** 803 SUPERIOR ST, PORT HURON, MI 48060-3764
- **Mailing address phone:** (810) 987-7224
- **Mailing address fax:** (810) 987-8585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 10502 | MI | Yes |

## Other

- **Enumeration date:** 05/14/2008
- **Last updated:** 05/14/2008