Bluestone Oral and Maxillofacial Surgery, P.a.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A.

Practice address

1616 Cloquet Ave
Cloquet, MN 55720-1948

Phone

(218) 879-3761

Fax

(218) 879-6057

NPI assigned

Oct 16, 2008

Organization subpart

Yes

Parent organization

BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A.As reported in NPPES

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

Authorized official

Name

Mrs. Jean Diane Southworth

Title

Business Managaer

Phone

(218) 727-8994

Specialties & licenses 1

Addresses

Other identifiers 6

Part of

Bluestone Oral Maxill

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bluestone Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Duluth, MN
  • NPI 1578511572
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David R Jennings, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Duluth, MN
  • NPI 1396740023
  NPD (past)
• John Tennis Keaveny, DDS OMS

  • Oral and Maxillofacial Surgery (Dentist)
  • Dickinson, ND
  • NPI 1770584500
  NPD (past)
• Scott Noren, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Ithaca, NY
  • NPI 1568591352
  NPD (past)

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1326290727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST",
            "address_2": "SUITE 720",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021701",
            "telephone_number": "218-727-8994",
            "fax_number": "218-727-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 CLOQUET AVE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201948",
            "telephone_number": "218-879-3761",
            "fax_number": "218-879-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLUESTONE ORAL AND MAXILLOFACIAL SURGERY, P.A.",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "SOUTHWORTH",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "BUSINESS MANAGAER",
        "authorized_official_telephone_number": "218-727-8994",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166644400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICAL GROUP#",
            "identifier": "DB2954",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (CLOUQET)",
            "identifier": "01630538",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN#",
            "identifier": "U12947",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (DULUTH)",
            "identifier": "01630541",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD MN",
            "identifier": "6B297JE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Berndt, DC
• Lindsie Biggerstaff, M.A. CCC-SLP
• Bio-Medical Applications of Minnesota, Inc. (Fresenius Medical Care Cloquet)
• Birch & Pine Counseling PLLP
• Ryder Blu
• Shelia Marie Bollum, LICSW
• Patrick Francis Boyle, ANP
• Ellise Caroline Braveheart, RN, CNP, FNP-C
• Shelly A Breyen, M.D.
• Brightwater Health Dba Human Development Center

• Oral and Maxillofacial Surgery (Dentist) in Cloquet, MN
• Providers in Cloquet, 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 Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.