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Organization
KENNETH R,. RUSSELL, D.D.S. PA
Active
Organization
KENNETH R,. RUSSELL, D.D.S. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH RAY RUSSELL D.D.S. (PRESIDENT)
(336) 768-7940
Entity
Organization
Contact information
Practice address
1480 RYMCO DR STE B, WINSTON SALEM, NC 27103-2944
(336) 768-7940
(336) 768-5985
Mailing address
1480 RYMCO DR STE B, WINSTON SALEM, NC 27103-2944
(336) 768-7940
(336) 768-5985
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5843
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890195B
—
NC
Enumeration date
01/08/2008
Last updated
01/08/2008
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