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BLUESTONE ORAL AND MAXILLOFACIAL SURGERY P.A. NPI 1326290727


NPI Information

NPI: 1326290727
Provider Name: BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A.
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
1616 CLOQUET AVE
CLOQUET, MN
ZIP 55720
Phone: (218) 879-3761
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BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A. is an oral and maxillofacial surgery dentist in Cloquet, MN. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A. NPI is 1326290727. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1616 CLOQUET AVE
CLOQUET, MN
ZIP 55720-948
Phone: (218) 879-3761
Fax: (218) 879-6057

The provider's authorized official is Jean Diane Southworth .
The authorized official title is Business Managaer and has the following contact phone number (218) 727-8994.

The enumeration date for this NPI number is 10/16/2008 and was last updated on 10/16/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryMINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
101630538OTHERMINNESOTAUNITED CONCORDIA (CLOUQET)
2166644400MEDICAIDMINNESOTA
3C03316MEDICARE PINMINNESOTA
46B297JEOTHERMINNESOTABLUE CROSS/BLUE SHIELD MN
5U12947OTHERMINNESOTAUPIN#
601630541OTHERUNITED CONCORDIA (DULUTH)
7DB2954OTHERMINNESOTARAILROAD MEDICAL GROUP#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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