# SHARON RUSSELL DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Maryland Oral Surgery Group and Implant Center of Bowie
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114629334
- **Authorized official:** MR. MARK RUSSELL (OPERATIONS MANAGER)
- **Authorized official phone:** (301) 967-0183

## Contact information

- **Practice address:** 14300 GALLANT FOX LN STE 220, BOWIE, MD 20715-4033
- **Practice address phone:** (301) 967-0183
- **Practice address fax:** (301) 576-5800
- **Mailing address:** 9632 MARLBORO PIKE, UPPER MARLBORO, MD 20772-3767
- **Mailing address phone:** (301) 967-0183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/21/2023
- **Last updated:** 03/21/2023