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
—
—
Other
Enumeration date
11/25/2025
Last updated
11/25/2025
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