Look up the most recent NPI and PECOS records

Maize Llc

(Bluejay Family Dentistry)

Clinic/Center

Ambulatory Health Care Facilities

1975 11th Ave E, Maplewood, MN 55109-5148

(651) 770-2900 (612) 735-4818

PECOS Enrollment

Based on the most recent information from CMS, provider Maize Llc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1407362205
Provider Type
Organization
Full Name
Maize Llc
Other Name
Bluejay Family Dentistry

Subpart
No
Enumeration Date
12/17/2017
Last Updated
12/17/2017

Contact Information

Practice Location

1975 11th Ave E, Maplewood, MN 55109-5148

(651) 770-2900

Unlisted Fax

Mailing Location

2860 105th Ave NE, Blaine, MN 55449-5212

(612) 735-4818

Unlisted Fax

Authorized Official

Simonson, Alexis (Owner)

(612) 735-4818

Provider Taxonomies

Code	Description	License
Code 261QD0000X Primary	Description Clinic/Center Ambulatory Health Care Facilities	License Unlisted Issuer

Maize Llc

(Bluejay Family Dentistry)

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Institute Of Facial Surgery St Paul, Pllc

Moua Family Dentistry Pc

Michael Henrickson Dds

Nerness Endodontics, P.C.

123 Brush Dental Llc

Dr. Roger C. Stoddard Dds, Pa

James G Koller Dds,Pa

Quality Dentistry Inc