MEDICARE: LAKE OSWEGO SMILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1952577058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE OSWEGO SMILES

Provider Business Mailing Address
First Line	:	16699 BOONES FERRY RD
Second Line	:	STE 200
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4368
Country	:	US
Telephone Number	:	503-635-3653
Fax Number	:	503-635-3654

Provider Business Practice Location Address
First Line	:	16699 BOONES FERRY RD
Second Line	:	STE 200
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4368
Country	:	US
Telephone Number	:	503-635-3653
Fax Number	:	503-635-3654

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. COLIN L SMITH
Credential	:	DMD
Telephone Number	:	503-635-3653

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/16/2008

Similar Medicare Providers

1093653099 — SYNCHRONOUS LLC
Practice Location Address:

16679 BOONES FERRY RD STE 205
LAKE OSWEGO, OR
97035-4368

Practice Phone: 503-635-2100
Practice Fax: 503-635-9188

1568476406 — DR. PAUL PETER ORTNER IV DDS, CAGS
Practice Location Address:

16679 BOONES FERRY RD STE 205
LAKE OSWEGO, OR
97035-4368

Practice Phone: 503-635-2100
Practice Fax: 503-635-9188

1639346778 — DR. COLIN L SMITH DMD
Practice Location Address:

16699 BOONES FERRY RD , STE 200
LAKE OSWEGO, OR
97035-4368

Practice Phone: 503-635-3653
Practice Fax: 503-635-3654

1457517138 — GENESIS MEDICAL GROUP, LLC.
Practice Location Address:

16679 BOONES FERRY RD STE 215
LAKE OSWEGO, OR
97035-4368

Practice Phone: 503-699-1911
Practice Fax: 503-699-1912

1295404986 — MARLO BULZA DMD
Practice Location Address:

16679 BOONES FERRY RD STE 215
LAKE OSWEGO, OR
97035-4368

Practice Phone: 503-636-7601
Practice Fax: 503-636-3749

1073497178 — ANNA BALL DMD
Practice Location Address:

16679 BOONES FERRY RD STE 215
LAKE OSWEGO, OR
97035-4368

Practice Phone: 503-636-7601
Practice Fax: 503-636-3749

Directions to “LAKE OSWEGO SMILES ” Practice Location

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