Individual
DR. ERIC GORDON RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4465 S 900 E STE 100, SALT LAKE CITY, UT 84124-2695
(801) 281-0100
Mailing address
2320 E LAMBOURNE AVE, SALT LAKE CITY, UT 84109-2708
(801) 644-4605
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7301384-9922
UT
Other
Enumeration date
05/29/2018
Last updated
05/29/2018
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