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Organization
NORTHWEST ORAL AND MAXILLOFACIAL SURGEONS
Active
Organization
NORTHWEST ORAL AND MAXILLOFACIAL SURGEONS
Active
Other names
Beacon Oral and Maxillofacial Surgeons
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL A LIEBLICK D.M.D. (OWNER)
(503) 665-7882
Entity
Organization
Contact information
Practice address
24850 SE STARK ST STE 100, GRESHAM, OR 97030-8317
(503) 665-7882
(503) 665-6983
Mailing address
24850 SE STARK ST STE 100, GRESHAM, OR 97030-8317
(503) 665-7882
(503) 665-6983
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D8342
OR
Other
Enumeration date
10/22/2013
Last updated
10/22/2013
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