Individual
BENJAMIN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2700 HOMESTEAD RD, #130, PARK CITY, UT 84098-4857
(435) 940-9900
Mailing address
2700 HOMESTEAD RD, #130, PARK CITY, UT 84098-4857
(435) 940-9900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5729440
UT
Other
Enumeration date
02/06/2014
Last updated
02/06/2014
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