Individual
DR. JASON EDWARD RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
510 FERNDALE BLVD, HIGH POINT, NC 27262-4761
(336) 402-3313
Mailing address
510 FERNDALE BLVD, HIGH POINT, NC 27262-4761
(336) 402-3313
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9115
NC
Other
Enumeration date
05/20/2011
Last updated
05/20/2011
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