Individual
DR. DAVID LEE RUSSELL SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS.
Contact information
Practice address
14 RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1642
(850) 863-3194
(850) 863-8875
Mailing address
14 RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1642
(850) 863-3194
(850) 863-8875
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9126
FL
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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