BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC
NPI 1316535339
Clinic/Center - Oral and Maxillofacial Surgery in Gresham, OR

Q: What is Blue Lake Oral And Maxillofacial Surgery, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Oral and Maxillofacial Surgery, with taxonomy code 261QS0112X.

Active since January 05, 2021

1201 SE 223RD AVE STE 180, GRESHAM, OR 97030(503) 667-1431 Get Directions Write a Review

NPPES record last updated: January 18, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 18, 2021, Jan 5, 2021 (2 updates tracked since 2021).

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About Blue Lake Oral And Maxillofacial Surgery, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC (NPI 1316535339) is a healthcare organization registered as an oral and maxillofacial surgery in Gresham, Oregon and active in the NPI registry since January 2021. The organization lists Julie Ann Smith, Oral And Maxillofacial Surgeon, as its authorized official.

NPPES Registry Identity

NPI1316535339

Entity TypeOrganization

Primary Taxonomy261QS0112X

Legal Business NameBLUE LAKE ORAL AND MAXILLOFACIAL SURGERY, PC

Location Address1201 SE 223RD AVE STE 180Gresham, OR 97030-2577

Mailing Address1201 Se 223rd Ave Ste 180Gresham, OR 97030-2577 · (503) 667-1431

Phone(503) 667-1431

Organization SubpartNo

Authorized OfficialJulie Ann SmithOral And Maxillofacial Surgeon · (503) 667-1431

Enumeration DateJanuary 5, 2021

Last NPPES UpdateJanuary 18, 20212 updates tracked since enumeration

NPPES CertifiedJanuary 18, 2021

✔ NPI 1316535339 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Oral and Maxillofacial SurgeryAmbulatory Health Care Facilities

Taxonomy Code261QS0112X

Definition

An oral and maxillofacial surgery clinic or center specialized in 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.

1201 SE 223RD AVE STE 180, Gresham, OR 97030

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ERIK MANUEL RICHMOND DMD

Dentist (Oral and Maxillofacial Surgery)

1201 SE 223RD AVE STE 180
GRESHAM, OR 97030

Multnomah County (503) 667-1431

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blue Lake Oral And Maxillofacial Surgery, PC's NPI number?

The NPI number for Blue Lake Oral And Maxillofacial Surgery, PC is 1316535339. It was assigned to this organization in the NPPES registry on January 5, 2021.

Where is Blue Lake Oral And Maxillofacial Surgery, PC located?

Blue Lake Oral And Maxillofacial Surgery, PC is located at 1201 SE 223rd Ave Ste 180, Gresham, OR 97030. The listed phone number is (503) 667-1431.

What is Blue Lake Oral And Maxillofacial Surgery, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Oral and Maxillofacial Surgery, with taxonomy code 261QS0112X.

When was this NPI record last updated?

The NPPES record for Blue Lake Oral And Maxillofacial Surgery, PC was last updated on January 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.