Organization
BILLY D RUSSOM, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE HAYES (INSURANCE CLERK)
(870) 857-3557
Entity
Organization
Contact information
Practice address
211 HOSPITAL DR, CORNING, AR 72422-7259
(870) 857-3557
(870) 857-5128
Mailing address
PO BOX 435, CORNING, AR 72422-0435
(708) 573-5578
(870) 857-5128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114013067
—
AR
Enumeration date
12/01/2020
Last updated
12/01/2020
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