Organization
DR ALAN RUSSELL PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY HUBRED CRDA (DENTAL ASSISTANT)
(612) 336-8478
Entity
Organization
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
122300000X
Dentist
Primary
09480
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13D69RU
BLUE CROSS BLUE SHIELD
MN
05
—
160213600
—
MN
01
—
710609
UNITED OF CONCORDIA
MN
Enumeration date
03/24/2008
Last updated
06/11/2008
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