| Blue Diamond Family Dental Sc | |
|
1502 Main St Bloomer WI 54724-1686 | |
| (715) 568-2363 | |
| (715) 568-2373 |
| Full Name | Blue Diamond Family Dental Sc |
|---|---|
| Speciality | Dentist |
| Location | 1502 Main St, Bloomer, Wisconsin |
| Authorized Official Name and Position | Connie C Parr (BUSINESS MANAGER) |
| Authorized Official Contact | 7155682363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Diamond Family Dental Sc 1502 Main St Bloomer WI 54724-1686 Ph: (715) 568-2363 | Blue Diamond Family Dental Sc 1502 Main St Bloomer WI 54724-1686 Ph: (715) 568-2363 |
| NPI Number | 1245433580 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245433580 | NPI | - | NPPES |
| 38390300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |