Individual
BRETT V RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2310 FORUM BLVD, SUITE A, COLUMBIA, MO 65203-5461
(573) 446-0032
(573) 446-0238
Mailing address
2310 FORUM BLVD, SUITE A, COLUMBIA, MO 65203-5461
(573) 446-0032
(573) 446-0238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12933
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103550
BLUE CROSS BLUE SHIELD
MO
01
—
860382
UNITED CONCORDIA
MO
Enumeration date
05/16/2007
Last updated
06/16/2009
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