| NPI | 1952717084 |
|---|---|
| Former Legal Business Name | PORTLAND ORAL & MAXILLOFACIAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | RUSSELL J COLLETT Oral Surgeon 207-772-8055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-03-17 |