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
1201 SE 223RD AVE, SUITE 180, GRESHAM, OR 97030-2574
(503) 667-1431
(503) 492-0880
Mailing address
1201 SE 223RD AVE, SUITE 180, GRESHAM, OR 97030-2574
(503) 667-1431
(503) 492-0880
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D6660
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D7053
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9295
OR
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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