Blue Water Dental Group Port Huron P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10502 Issued in MI

Legal business name

BLUE WATER DENTAL GROUP PORT HURON P.C.

Practice address

803 Superior St
Port Huron, MI 48060-3764

Phone

(810) 987-7224

Fax

(810) 987-8585

NPI assigned

May 14, 2008

Organization subpart

No

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

Authorized official

Name

Luann Thompson

Title

Office Manager

Phone

(810) 987-7224

Specialties & licenses 1

Addresses

Practitioners 1

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

• Glenn Keith Wendela, D.D.S

  • General Practice Dentistry
  • Port Huron, MI
  • NPI 1447266481
  NPD (past)

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1669649026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 SUPERIOR ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603764",
            "telephone_number": "810-987-7224",
            "fax_number": "810-987-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 SUPERIOR ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603764",
            "telephone_number": "810-987-7224",
            "fax_number": "810-987-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER DENTAL GROUP PORT HURON P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "LUANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "810-987-7224"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "10502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Ann Bloink
• Jeanette Joy Bloink, RN
• Blue Water ASC LLC (Blue Water Surgery Center, LLC)
• Blue Water Center for Christian Counseling P.C.
• Blue Water Center for Independent Living
• Blue Water Eye Care Associates PC
• Blue Water Internal Medicine, PC
• Blue Water Medical Massage PLLC
• Blue Water Medical PLLC
• Blue Water OB & GYN PC

• General Practice Dentistry in Port Huron, MI
• Providers in Port Huron, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.