NPIMap

Organization Active NPI

Humble Richmond & Russell Oral & Maxillofacial Surgery, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gresham, OR
National Provider Identifier
1902100316
Registry record updated Dec 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D6660 Issued in OR
Legal business name
HUMBLE RICHMOND & RUSSELL ORAL & MAXILLOFACIAL SURGERY, LLC
Practice address
1201 SE 223Rd Ave
Suite 180
Gresham, OR 97030-2574
Phone
(503) 667-1431
Fax
(503) 492-0880
NPI assigned
Dec 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2010

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

Authorized official

Name
Denise Olson
Title
Bookkeeper
Phone
(503) 667-1431

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X D6660 OR Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X D7053 OR
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X D9295 OR

Addresses

Primary practice location

1201 SE 223Rd Ave
Suite 180
Gresham, OR 97030-2574

Mailing address

1201 SE 223Rd Ave
Suite 180
Gresham, OR 97030-2574
Phone (503) 667-1431

National Provider Directory

National Provider Directory
Tax ID family
Humble Richmond Russell Oral Maxillofacial Surgery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293494400000",
    "number": "1902100316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SE 223RD AVE",
            "address_2": "SUITE 180",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970302574",
            "telephone_number": "503-667-1431",
            "fax_number": "503-492-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SE 223RD AVE",
            "address_2": "SUITE 180",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970302574",
            "telephone_number": "503-667-1431",
            "fax_number": "503-492-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBLE RICHMOND & RUSSELL ORAL & MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2010-12-28",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "BOOKKEEPER",
        "authorized_official_telephone_number": "503-667-1431"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D6660",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D7053",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D9295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.