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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