# DR. RUSSELL TRITAPOE DDS PLLC

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

## Provider details

- **NPI number:** 1609250729
- **Authorized official:** DR. RUSSELL TRITAPOE DDS (OWNER)
- **Authorized official phone:** (304) 298-3501

## Contact information

- **Practice address:** 58 PRESIDENTS STREET, FORT ASHBY, WV 26719-0738
- **Practice address phone:** (304) 298-3501
- **Practice address fax:** (304) 298-3406
- **Mailing address:** PO BOX 738, FORT ASHBY, WV 26719-0738
- **Mailing address phone:** (304) 298-3501
- **Mailing address fax:** (304) 298-3406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3997 | WV | Yes |

## Other

- **Enumeration date:** 07/18/2015
- **Last updated:** 07/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810025875 | — | WV |