Organization
BLUE WATER DENTAL GROUP MARYSVILLE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM LEE KILE DDS FICCMO (PRESIDENT)
(810) 364-7601
Entity
Organization
Contact information
Practice address
1616 GRATIOT BLVD, MARYVILLE, MI 48040-1181
(810) 364-7601
(810) 364-9010
Mailing address
1616 GRATIOT BLVD, MARYVILLE, MI 48040-1181
(810) 364-7601
(810) 364-9010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901008847
MI
Other
Enumeration date
08/29/2006
Last updated
08/22/2020
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