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Individual
DR. BRADLY KALB RUSSELL
Active
Individual
DR. BRADLY KALB RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
11536
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
30-023991
OH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30.0239911
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Enumeration date
04/20/2011
Last updated
10/06/2021
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