| Beacon Oral And Maxillofacial Surgeons | |
|
24850 Se Stark St Ste 100 Gresham OR 97030-8317 | |
| (503) 665-7882 | |
| (503) 665-6983 |
| Full Name | Beacon Oral And Maxillofacial Surgeons |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 24850 Se Stark St Ste 100, Gresham, Oregon |
| Authorized Official Name and Position | Russell A Lieblick (OWNER) |
| Authorized Official Contact | 5036657882 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Oral And Maxillofacial Surgeons 24850 Se Stark St Ste 100 Gresham OR 97030-8317 Ph: (503) 665-7882 | Beacon Oral And Maxillofacial Surgeons 24850 Se Stark St Ste 100 Gresham OR 97030-8317 Ph: (503) 665-7882 |
| NPI Number | 1417385857 |
|---|---|
| Provider Enumeration Date | 10/22/2013 |
| Last Update Date | 10/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417385857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D8342 (Oregon) | Primary |
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