# SPECIAL NEEDS DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023408192
- **Authorized official:** DR. RUSSELL WAYNE REDDELL DDS (OWNER/MANAGER)
- **Authorized official phone:** (806) 701-5066

## Contact information

- **Practice address:** 2420 QUAKER AVE, SUITE 101, LUBBOCK, TX 79410-1817
- **Practice address phone:** (806) 701-5066
- **Mailing address:** 16304 COUNTY ROAD 2040, LUBBOCK, TX 79423-4618
- **Mailing address phone:** (806) 368-2005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223D0001X | Public Health Dentistry | 19405 | TX | Yes |

## Other

- **Enumeration date:** 01/28/2015
- **Last updated:** 01/28/2015