Individual
BENJAMIN T RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
742 NE DIVISION ST STE 102, GRESHAM, OR 97030-3979
(503) 667-2442
Mailing address
363 SE 4TH AVE, HILLSBORO, OR 97123-4281
(503) 756-9046
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D8729
OR
Other
Enumeration date
12/08/2006
Last updated
07/17/2019
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