Individual
MR. RUSSELL EUGENE BIBB JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
103 SW HWY 224, STE A, ESTACADA, OR 97023
(503) 630-4211
(503) 630-4260
Mailing address
PO BOX 960, ESTACADA, OR 97023
(503) 630-4211
(503) 630-4260
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AD6154
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22197-8
—
OR
01
—
AD6154
OREGON DENTAL
OR
Enumeration date
09/26/2006
Last updated
03/07/2023
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