OrganizationActive
Blue Lake Oral and Maxillofacial Surgery, PC
NPI 1316535339 · Oral and Maxillofacial Surgery Clinic/Center · Gresham, OR
Provider details
- NPI number
- 1316535339
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Julie Ann Smith, Oral and Maxillofacial Surgeon
Practice location
1201 Se 223rd Ave Ste 180
Gresham, OR 97030-2577
Phone: (503) 667-1431
Mailing address
1201 Se 223rd Ave Ste 180
Gresham, OR 97030-2577
Registry dates
- Enumerated
- 2021-01-05
- Last updated
- 2021-01-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.