Individual
DR. ALAN L RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2010 27TH AVE S, MINNEAPOLIS, MN 55406-1108
(612) 336-8478
Mailing address
2010 27TH AVE S, MINNEAPOLIS, MN 55406-1108
(612) 336-8478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9480
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13D69RU
BLUE CROSS BLUE SHIELD ID
MN
01
—
710609
UNITED OF CONCORDIA ID #
MN
Enumeration date
02/15/2006
Last updated
07/09/2007
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