Individual
DAVID WAYNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4171 NORTHRISE DRIVE, LAS CRUCES, NM 88011
(575) 521-9375
(575) 521-2637
Mailing address
4171 NORTHRISE DRIVE, LAS CRUCES, NM 88011
(575) 521-9375
(575) 521-2637
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4897
NM
1223G0001X
General Practice Dentistry
DD4897
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81627718
—
NM
Enumeration date
06/13/2018
Last updated
08/12/2024
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