Individual
DR. JASON PHILIP RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2416 FRANKFORT AVE, SUITE 3, LOUISVILLE, KY 40206-2571
(502) 893-1990
(502) 893-3690
Mailing address
2416 FRANKFORT AVE, SUITE 3, LOUISVILLE, KY 40206-2571
(502) 893-1990
(502) 893-3690
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7604
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015111
PASSPORT PROVIDER NO.
KY
Enumeration date
10/12/2005
Last updated
07/08/2007
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