Blue Lake Smiles
NPI #1598627820 in Fond Du Lac, Wisconsin
Provider Information
- NPI Number
- 1598627820
- Entity Type
- Organization
- Organization Name
- Blue Lake Smiles
- Primary Specialty
- Dentist - Pediatric Dentistry
- Enumeration Date
- Nov 25, 2025
- Last Updated
- Nov 25, 2025
Practice Location
- Address
- 845 S MAIN ST STE 130
- City
- Fond Du Lac
- State
- Wisconsin
- ZIP Code
- 54935-6116
- Phone
- (920) 581-8505
Authorized Official
- Name
- GAURAV JAIN, DDS
- Title
- PEDIATRIC DENTIST
- Phone
- (612) 308-2244
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Pediatric Dentistry — Pediatric Dentistry |
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