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Individual
DR. WILLARD DEAN RUSSELL JR.
Active
Individual
DR. WILLARD DEAN RUSSELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2483
WV
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6261
MD
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS030508L
PA
Other
Enumeration date
10/23/2006
Last updated
05/30/2012
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