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General NPI Number Information
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NPI Number | 1659238038
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Entity Type | Organization
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Legal Business Name | PORTLAND ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 5050 NE HOYT ST STE 322
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City | PORTLAND
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State | OR
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Zip | 97213-2982
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Country | US
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Telephone | 503-230-0322
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Fax | 503-230-0344
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Provider Business Mailing Address
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Address Line | 1849 NW KEARNEY ST STE 300
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City | PORTLAND
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State | OR
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Zip | 97209-1453
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Country | US
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Telephone | 503-525-3632
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Fax | 971-279-4603
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SHANNON GRESH
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Credential |
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Telephone | 503-525-3632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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