| Oral And Maxillofacial Surgical Associates | |
|
1000 East First Street #302 Duluth MN 55805-2297 | |
| (218) 722-1854 | |
| (218) 722-6424 |
| Full Name | Oral And Maxillofacial Surgical Associates |
|---|---|
| Speciality | Dentist |
| Location | 1000 East First Street #302, Duluth, Minnesota |
| Authorized Official Name and Position | Paul Kevin Hodapp (SECRETARY/TREASURER) |
| Authorized Official Contact | 2187221854 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral And Maxillofacial Surgical Associates 1000 East First Street #302 Duluth MN 55805-2297 Ph: (218) 722-1854 | Oral And Maxillofacial Surgical Associates 1000 East First Street #302 Duluth MN 55805-2297 Ph: (218) 722-1854 |
| NPI Number | 1104911056 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 09/04/2014 |
| Medicare PECOS PAC ID | 4880779321 |
|---|---|
| Medicare Enrollment ID | O20081031000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104911056 | NPI | - | NPPES |
| 998722300 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Scott K Varland |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255505996 PECOS PAC ID: 9032278205 Enrollment ID: I20081103000160 |
| Provider Name | Paul K Hodapp |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750475299 PECOS PAC ID: 0244315786 Enrollment ID: I20100215000825 |
| Provider Name | Nathan Anton Jarnot |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710274261 PECOS PAC ID: 7113233859 Enrollment ID: I20170807002085 |
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