Organization
HUMBLE RICHMOND & RUSSELL ORAL & MAXILLOFACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE OLSON (BOOKKEEPER)
(503) 667-1431
Entity
Organization
Contact information
Practice address
911 MAIN ST STE 180, OREGON CITY, OR 97045-1870
(503) 650-6116
(503) 650-6198
Mailing address
911 MAIN ST STE 180, OREGON CITY, OR 97045-1870
(503) 650-6116
(503) 650-6198
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D6660
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D7053
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9295
OR
Other
Enumeration date
01/06/2011
Last updated
01/06/2011
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