Organization
ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES PA
Active
Other names
Blue Water Oral and Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE ANNE LAFLEUR MBA (PRACTICE ADMINISTRATOR)
(218) 722-1854
Entity
Organization
Contact information
Practice address
303 SE 1ST ST, GRAND RAPIDS, MN 55744-3681
(218) 326-0349
(218) 326-5005
Mailing address
303 SE 1ST ST, GRAND RAPIDS, MN 55744-3681
(218) 326-0349
(218) 326-5005
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
861461000
—
MN
Enumeration date
10/04/2006
Last updated
02/06/2025
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