Individual
DR. RUSSELL POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
329 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-3388
(208) 453-9295
Mailing address
1807 S CRIMSON ROSE AVE, BOISE, ID 83709-8228
(208) 440-0885
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4762
ID
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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