=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912249566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORAL SURGERY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3640 NW SAMARITAN DRIVE SUITE 260
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-757-1566
-----------------------------------------------------
Fax | 541-757-1568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3640 NW SAMARITAN DRIVE SUITE 260
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-757-1566
-----------------------------------------------------
Fax | 541-757-1568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT C SCHLEGEL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 541-757-1566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | D4771
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------