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Individual
RUSSELL FULLER MCKINLEY
Active
Individual
RUSSELL FULLER MCKINLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1869
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010012469
BLUE SHIELD
ID
01
—
000010012469
CARING FOUNDATION BLUE SH
—
01
—
3127302
BLUE CROSS BLUE SHIELD TN
—
01
—
532545
UNITED CONCORDIA
—
01
—
69450
BLUE CROSS
ID
Enumeration date
07/19/2006
Last updated
07/08/2007
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