Individual
BRADFORD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3005 FALLING LEAF CT, SUITE 101, COLUMBIA, MO 65201-3549
(573) 875-7040
Mailing address
3005 FALLING LEAF CT, COLUMBIA, MO 65201-3549
(573) 875-7040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13572
MO
Other
Enumeration date
07/27/2006
Last updated
04/22/2008
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