Blue Lake Oral and Maxillofacial Surgery, PC

NPI #1316535339 in Gresham, Oregon

Provider Information

NPI Number
1316535339
Entity Type
Organization
Organization Name
Blue Lake Oral and Maxillofacial Surgery, PC
Primary Specialty
Clinic/Center - Oral and Maxillofacial Surgery
Enumeration Date
Jan 5, 2021
Last Updated
Jan 18, 2021

Practice Location

Address
1201 SE 223RD AVE STE 180
State
Oregon
ZIP Code
97030-2577
Phone
(503) 667-1431

Authorized Official

Name
DR. JULIE ANN SMITH, DDS, MD
Title
ORAL AND MAXILLOFACIAL SURGEON
Phone
(503) 667-1431

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Oral and Maxillofacial SurgeryOral and Maxillofacial Surgery

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