Organization
BLUE DIAMOND FAMILY DENTAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE C PARR (BUSINESS MANAGER)
(715) 568-2363
Entity
Organization
Contact information
Practice address
1502 MAIN ST, BLOOMER, WI 54724-1686
(715) 568-2363
(715) 568-2373
Mailing address
1502 MAIN ST, BLOOMER, WI 54724-1686
(715) 568-2363
(715) 568-2373
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38390300
—
WI
Enumeration date
06/06/2007
Last updated
08/22/2020
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