| Blue Lake Smiles | |
|
845 S Main St Ste 130 Fond Du Lac WI 54935-6116 | |
| (920) 581-8505 | |
| Not Available |
| Full Name | Blue Lake Smiles |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 845 S Main St Ste 130, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Gaurav Jain (PEDIATRIC DENTIST) |
| Authorized Official Contact | 6123082244 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lake Smiles 10749 N Tree Sparrow Dr Mequon WI 53097 Ph: (612) 308-2244 | Blue Lake Smiles 845 S Main St Ste 130 Fond Du Lac WI 54935-6116 Ph: (920) 581-8505 |
| NPI Number | 1598627820 |
|---|---|
| Provider Enumeration Date | 11/25/2025 |
| Last Update Date | 11/25/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598627820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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