COLUMBIA PARK ORAL SURGERY PC NPI 1639103658

NPI Information

COLUMBIA PARK ORAL SURGERY PC is an oral and maxillofacial surgery dentist in Portland, OR. The provider is the specialty of dentistry which includes 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. COLUMBIA PARK ORAL SURGERY PC NPI is 1639103658. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3549 N LOMBARD
PORTLAND, OR
ZIP 97217-901
Phone: (503) 289-9621
Fax: (503) 289-2930

The provider's authorized official is Jan A Kooning .
The authorized official title is President and has the following contact phone number (503) 289-9621.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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