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

Doing business as

Blue Water Oral and Facial Surgery

Practice address

303 SE 1St St
Grand Rapids, MN 55744-3681

Phone

(218) 326-0349

Fax

(218) 326-5005

NPI assigned

Oct 4, 2006

Last updated

Feb 6, 2025By the provider in NPPES

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

  dba Blue Water Oral and Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Duluth, MN
  • NPI 1104911056

  O20081031000317

  Same enrollment
• Oral and Maxillofacial Surgical Associates PA

  dba Blue Water Oral and Facial Surgery

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

  O20081031000317

  Same enrollment

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": "1679668529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 SE 1ST ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443681",
            "telephone_number": "218-326-0349",
            "fax_number": "218-326-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 SE 1ST ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443681",
            "telephone_number": "218-326-0349",
            "fax_number": "218-326-5005"
        }
    ],
    "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": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "861461000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Water Oral and Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela M Olson, SLP
• Paul Norman Olson, M.D.
• Stacy Olson, LICSW
• Traci Kay Olson, RNFA
• Jared Onder, CRNA
• Heather A Orhn, WHCNP
• Matt John Oven
• Michelle Overbye, MSN, APRN, FNP-C
• Debra Overlee, LICSW
• Kelly Owens

• Oral and Maxillofacial Surgery (Dentist) in Grand Rapids, MN
• Providers in Grand Rapids, 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.