Individual
DR. CHARLES MARK RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
163 BEECH ST, HARROGATE, TN 37752-8208
(423) 869-5485
Mailing address
163 BEECH ST, HARROGATE, TN 37752-8208
(423) 869-5485
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3578
TN
Other
Enumeration date
06/09/2005
Last updated
07/08/2007
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