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Blue Lake Oral And Maxillofacial Surgery, Pc
Oral and Maxillofacial Surgery Clinic/Center in Gresham, Oregon
NPI 1316535339

Blue Lake Oral And Maxillofacial Surgery, Pc is a Oral and Maxillofacial Surgery Clinic/Center based in Gresham, OR and is specialized in Oral and Maxillofacial Surgery. Blue Lake Oral And Maxillofacial Surgery, Pc practices in Gresham, OR. The NPI Number for Blue Lake Oral And Maxillofacial Surgery, Pc is 1316535339 and holds a License No. (Oregon).

The current practice location address for Blue Lake Oral And Maxillofacial Surgery, Pc is 1201 Se 223Rd Ave Ste 180, Gresham, OR and can be reached out via phone at 503-667-1431.

Location: 1201 Se 223Rd Ave Ste 180, Gresham, OR, 97030-2577
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1316535339
Provider Name
Blue Lake Oral And Maxillofacial Surgery, Pc
Credential
Provider Entity Type
Organization
Address
1201 Se 223Rd Ave Ste 180, Gresham, OR, 97030-2577
Phone Number
503-667-1431
Fax Number
Provider Enumeration Date
01/05/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1201 Se 223Rd Ave Ste 180
City
Gresham
State
Oregon
Zip
97030-2577
Phone Number
503-667-1431
Fax Number
person
Provider Business Mailing Address Details
Address
1201 Se 223Rd Ave Ste 180
City
Gresham
State
Oregon
Zip
97030-2577
Phone Number
503-667-1431
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Oral and Maxillofacial Surgery
Taxonomy
261QS0112X
License No.
()
Definition
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.
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