Organization
HEAD & NECK SURGICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON GRESH (CLINIC OPERATIONS MANAGER)
(503) 224-1371
Entity
Organization
Contact information
Practice address
1849 NW KEARNEY ST STE 300, PORTLAND, OR 97209-1453
(503) 224-1371
(503) 224-0722
Mailing address
1849 NW KEARNEY ST, SUITE 300, PORTLAND, OR 97209-1453
(503) 224-1371
(503) 224-0722
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
OR
207YX0901X
Otology & Neurotology Physician
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286589
—
OR
Enumeration date
12/27/2006
Last updated
05/21/2021
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