Individual
DR. RUSSELL STAGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
347 W MAIN ST, MORRISTOWN, IN 46161-9792
(765) 763-6412
Mailing address
3435 S OVERLOOK PASS, NEW PALESTINE, IN 46163-9484
(317) 861-9159
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010197
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200248770B
—
IN
Enumeration date
11/03/2006
Last updated
04/12/2012
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