Organization
BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIE ANN SMITH DDS, MD (ORAL AND MAXILLOFACIAL SURGEON)
(503) 667-1431
Entity
Organization
Contact information
Practice address
1201 SE 223RD AVE STE 180, GRESHAM, OR 97030-2577
(503) 667-1431
Mailing address
1201 SE 223RD AVE STE 180, GRESHAM, OR 97030-2577
(503) 667-1431
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
01/18/2021
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