Oral and Maxillofacial Surgical Associates PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES PA

Practice address

1000 E 1St St Ste 108
Duluth, MN 55805-2297

Phone

(218) 722-1854

Fax

(218) 722-6424

NPI assigned

Oct 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katherine Anne Lafleur, MBA

Title

Practice Administrator

Phone

(218) 722-1854

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Blue Water Oral and Facial Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Oral and Maxillofacial Surgical Associates PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Virginia, MN
  • NPI 1417042367

  O20081031000317

  Same enrollment
• Oral and Maxillofacial Surgical Associates PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Rapids, MN
  • NPI 1679668529

  O20081031000317

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1104911056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST STE 108",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-1854",
            "fax_number": "218-722-6424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST STE 108",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-1854",
            "fax_number": "218-722-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "LAFLEUR",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "218-722-1854",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "998722300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Water Oral and Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Op Orthodontics of Minnesota PLLC
• Emily Rose Opacich, RN, CNP
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• Thomas Opheim, M.D.
• Tigist Opheim, PA-C
• Laurie Orbeck, LICSW
• Cooper Orla
• Charles Orsak, LP, PHD
• Orthopedic Associates of Duluth, P.a.
• Brittany Ann Ortler, CNP

• Oral and Maxillofacial Surgery (Dentist) in Duluth, MN
• Providers in Duluth, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.