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General NPI Number Information
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NPI Number | 1104911056
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES PA
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1000 E 1ST ST STE 108
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City | DULUTH
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State | MN
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Zip | 55805-2297
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Country | US
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Telephone | 218-722-1854
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Fax | 218-722-6424
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Provider Business Mailing Address
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Address Line | 1000 E 1ST ST STE 108
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City | DULUTH
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State | MN
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Zip | 55805-2297
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Country | US
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Telephone | 218-722-1854
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Fax | 218-722-6424
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KATHERINE ANNE LAFLEUR
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Credential | MBA
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Telephone | 218-722-1854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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