Russell Eugene Bibb Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

AD6154 Issued in OR

Practice address

103 SW Hwy 224
Ste a
Estacada, OR 97023

Phone

(503) 630-4211

Fax

(503) 630-4260

NPI assigned

Sep 26, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1598866154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 960",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "97023",
            "telephone_number": "503-630-4211",
            "fax_number": "503-630-4260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SW HWY 224",
            "address_2": "STE A",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "97023",
            "telephone_number": "503-630-4211",
            "fax_number": "503-630-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIBB",
        "first_name": "RUSSELL",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "AD6154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON DENTAL",
            "identifier": "AD6154",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22197-8",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Estacada, OR
• Providers in Estacada, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.