Provider Demographics
NPI:1376310359
Name:SKYLINE ORAL FACIAL AND DENTAL IMPLANT SURGERY
Entity Type:Organization
Organization Name:SKYLINE ORAL FACIAL AND DENTAL IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-223-7332
Mailing Address - Street 1:11786 SW BARNES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5926
Mailing Address - Country:US
Mailing Address - Phone:503-924-2323
Mailing Address - Fax:
Practice Address - Street 1:11786 SW BARNES RD STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5926
Practice Address - Country:US
Practice Address - Phone:503-924-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty