Individual
LARRY DOBY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
519 W EUCLID AVE, PHOENIX, AZ 85041-8440
(602) 312-6003
Mailing address
519 W EUCLID AVE, PHOENIX, AZ 85041-8440
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5177
AZ
Other
Enumeration date
10/16/2007
Last updated
10/16/2007
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