National Provider Identifier Database

BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY PC
Oral and Maxillofacial Surgery

The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.


Contact Information

BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC
1201 SE 223RD AVE STE 180
GRESHAM, OR97030-2577
Phone: 503-667-1431
Fax:
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC

NPI Number 1316535339
Legal business name
LBN
BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC
Authorized official JULIE ANN SMITH - (ORAL AND MAXILLOFACIAL SURGEON)
Entity Organization
Organization subpart No
Enumeration date 01/05/2021
Last updated 01/18/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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