NORTHWEST ORAL AND MAXILLOFACIAL SURGEONS (NPI# 1417385857) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417385857 |
| Entity Type | Organization |
| Organization Name | NORTHWEST ORAL AND MAXILLOFACIAL SURGEONS |
| Other Organization Name | BEACON ORAL AND MAXILLOFACIAL SURGEONS |
| Practice Address |
24850 Se Stark St Ste 100 Gresham OR 97030-8317 |
| Practice Telephone | 5036657882 |
| Practice Fax Number | 5036656983 |
| Mailing Telephone | 5036657882 |
| Mailing Fax Number | 5036656983 |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2013-10-22 |
| Authorized Official Name | DR. RUSSELL A LIEBLICK (OWNER) |
| Authorized Official Telephone | 5036657882 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D8342 | OR | Dental Providers |
| Other Name | Type Code |
|---|---|
| Beacon Oral and Maxillofacial Surgeons | Doing Business As Name - Organization |
| Street Address |
24850 SE STARK ST STE 100 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-8317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861604555 | Erik Manuel Richmond | Dentist | 1201 Se 223rd Ave Ste 180, Gresham, OR 97030-2577 | 2007-05-04 |
| 1902100316 | Humble Richmond & Russell Oral & Maxillofacial Surgery, LLC | Dentist | 1201 Se 223rd Ave, Suite 180, Gresham, OR 97030-2574 | 2010-12-28 |
| 1619199007 | Humble & Richmond, PC | Dentist | 1201 Se 223rd, Suite 180, Gresham, OR 97030 | 2007-05-03 |
| 1407856156 | Russell Aron Lieblick | Dentist | 24850 Se Stark St, Suite 100, Gresham, OR 97030-8316 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831686468 | Jev A. Clark, Dmd, Md, LLC | Dentist | 120 Ramsgate Sq S Ste 110, Salem, OR 97302-5870 | 2018-04-19 |
| 1457699142 | Bryan Christopher Williams | Dentist | 330 S Garden Way Ste 140, Eugene, OR 97401 | 2013-01-30 |
| 1689932063 | Garrett Welch | Dentist | 1475 Sw Chandler Ave Ste 101, Bend, OR 97702 | 2012-04-24 |
| 1164712022 | Travis Jon Hamilton | Dentist | 250 Church St Se Ste 102, Salem, OR 97301-3758 | 2011-04-12 |
| 1770887648 | Humble Richmond & Russell Oral & Maxillofacial Surgery, LLC | Dentist | 911 Main St Ste 180, Oregon City, OR 97045-1870 | 2011-01-06 |
| 1710291265 | Auzins Warrenton LLC | Dentist | 65 N Highway 101 Ste C, Warrenton, OR 97146-9313 | 2010-07-27 |
| 1932411303 | Normund Karl Auzins Dds | Dentist | 1725 Saint Helens St, Saint Helens, OR 97051-1744 | 2010-07-13 |
| 1356662845 | Baber Nazir Khatib | Dentist | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2010-06-18 |
| 1700012010 | Dylan S Spendal | Dentist | 5025 Ne Elam Young Pkwy, Suite 100, Hillsboro, OR 97124-6403 | 2009-06-02 |
| 1841447240 | Reza J Sharifi | Dentist | 2790 Nw 188th Ave, Hillsboro, OR 97124-7447 | 2008-08-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.