Blue Lake Oral and Maxillofacial Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC

Practice address

1201 SE 223Rd Ave Ste 180
Gresham, OR 97030-2577

Phone

(503) 667-1431

NPI assigned

Jan 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Julie Ann Smith, DDS, MDNPI 1972588374

Title

Oral and Maxillofacial Surgeon

Phone

(503) 667-1431

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julie Ann Smith, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Portland, OR
  • NPI 1972588374
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610928000000",
    "number": "1316535339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SE 223RD AVE STE 180",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970302577",
            "telephone_number": "503-667-1431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SE 223RD AVE STE 180",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970302577",
            "telephone_number": "503-667-1431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JULIE ANN",
        "authorized_official_title_or_position": "ORAL AND MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "503-667-1431",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica S Blair, LMT
• Ruth Marian Blake, PT
• Jared Block, PHARMD
• Melanie J Block, LD
• Stephen Matthew Block, DPT
• Jeremy Patrick Boal, LCSW
• Bodies in Balance Chiropractic LLC
• Bodywork Massage Inc.
• Caitlynn Claire Didlick Bohman, LAC, DACM, MACOM
• Melissa Anne Bohnstedt, MS, CCC-SLP

• Oral and Maxillofacial Surgery Clinic/Center in Gresham, OR
• Providers in Gresham, OR by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.