Blue Lake Oral and Maxillofacial Surgery, PC
Blue Lake Oral and Maxillofacial Surgery, PC is an Oral and Maxillofacial Surgery Clinic/Center in Gresham, Oregon. Registered with an NPI since 2021.
- In the registry since
- 2021
What do these letters mean?
- PC — Professional corporation
- A form of business registration, not a clinical qualification.
Practice location Address checks out
1201 SE 223rd Ave Ste 180Gresham, OR 97030-2577
Phone: (503) 667-1431
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Oral and Maxillofacial Surgery Clinic/Center (primary) | Taxonomy 261QS0112X |
|---|
Record details
| NPI number | 1316535339 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Julie Ann Smith — Oral And Maxillofacial Surgeon · (503) 667-1431 |
| NPI enumerated | January 5, 2021 |
| Last updated in NPPES | January 18, 2021 |
| Certification date | January 18, 2021 |
| Mailing address | 1201 Se 223rd Ave Ste 180, Gresham, OR 97030-2577 |