Organization
JOHN RUSSELL, III, D.M.D., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RUSSELL III DMD (PRESIDENT)
(662) 328-1521
Entity
Organization
Contact information
Practice address
206 BROOKMOORE DRIVE, COLUMBUS, MS 39705
(662) 328-1521
(662) 328-1237
Mailing address
206 BROOKMOORE DRIVE, COLUMBUS, MS 39705
(662) 328-1521
(662) 328-1237
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
OR15888
MS
Other
Enumeration date
09/20/2006
Last updated
04/10/2009
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