Provider Demographics
NPI:1568568772
Name:VANCOUVER ORAL SURGERY GROUP
Entity Type:Organization
Organization Name:VANCOUVER ORAL SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOICE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-260-3290
Mailing Address - Street 1:300 SE 120TH AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4094
Mailing Address - Country:US
Mailing Address - Phone:360-260-3290
Mailing Address - Fax:360-260-3291
Practice Address - Street 1:300 SE 120TH AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4090
Practice Address - Country:US
Practice Address - Phone:360-260-3290
Practice Address - Fax:360-260-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty