MEDICARE: BLUEWATER FAMILY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1861940991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEWATER FAMILY DENTAL

Provider Business Mailing Address
First Line	:	2001 E BLUEWATER HWY
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-8725
Country	:	US
Telephone Number	:	616-523-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 E BLUEWATER HWY
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-8725
Country	:	US
Telephone Number	:	616-523-6151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIE EVA HEUHS
Credential	:
Telephone Number	:	517-256-3915

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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Directions to “BLUEWATER FAMILY DENTAL ” Practice Location

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