# RUSSELL FULLER MCKINLEY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1457370686
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1869 | ID | Yes |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 07/08/2007

## 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 |