Individual
KENNETH R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1480 RYMCO DR STE B, WINSTON SALEM, NC 27103-2944
(336) 768-7940
(336) 768-5985
Mailing address
1480 RYMCO DR STE B, WINSTON SALEM, NC 27103-2944
(336) 768-7940
(336) 768-5985
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5843
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8997537
—
NC
Enumeration date
09/26/2006
Last updated
07/09/2007
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