Organization Name: | YELLOW SPRINGS DENTAL CARE JOHN T RUSSELL DDS INC. |
NPI Number: | 1568684140 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN T RUSSELL (CLINICIAN) |
Mailing Address: | 1030 Xenia Ave Yellow Springs |
State: | OH US |
Postal Code: | 453871632 |
Phone Number: | 9377677731 |
Fax Number: | |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 05/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 30.013562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |