| Benjamin T Russell DMD LLC | |
|
742 Ne Division St Ste 102 Gresham OR 97030-3979 | |
| (503) 667-2442 | |
| Not Available |
| Full Name | Benjamin T Russell DMD LLC |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 742 Ne Division St Ste 102, Gresham, Oregon |
| Authorized Official Name and Position | Benjamin Russell (OWNER) |
| Authorized Official Contact | 5036672442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Benjamin T Russell DMD LLC 742 Ne Division St Ste 102 Gresham OR 97030-3979 Ph: (503) 667-2442 | Benjamin T Russell DMD LLC 742 Ne Division St Ste 102 Gresham OR 97030-3979 Ph: (503) 667-2442 |
| NPI Number | 1881247039 |
|---|---|
| Provider Enumeration Date | 07/17/2019 |
| Last Update Date | 07/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881247039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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