Organization
NORTHERN ORAL & MAXILLOFACIAL SURGEONS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES R BABST DDS (PRESIDENT)
(218) 722-8377
Entity
Organization
Contact information
Practice address
3617 W ARROWHEAD RD, DULUTH, MN 55811-4046
(218) 722-8377
(218) 722-3117
Mailing address
3617 W ARROWHEAD RD, DULUTH, MN 55811-4046
(218) 722-8377
(218) 722-3117
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2467529001
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38393400
WISCONSIN MEDICAID CLINIC
WI
01
—
60360BA
MINNESOTA BCBS CLINIC
MN
Enumeration date
01/10/2007
Last updated
03/05/2008
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