Healthcare Provider Details

I. General information

NPI: 1912249566
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 NW SAMARITAN DRIVE SUITE 260
CORVALLIS OR
97330
US

IV. Provider business mailing address

3640 NW SAMARITAN DRIVE SUITE 260
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-1566
  • Fax: 541-757-1568
Mailing address:
  • Phone: 541-757-1566
  • Fax: 541-757-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD4771
License Number StateOR

VIII. Authorized Official

Name: ROBERT C SCHLEGEL
Title or Position: OWNER
Credential: DMD
Phone: 541-757-1566