Individual
DR. ZACHARY D RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
344 HEARD STREET, BUILDING 556, SCHOFIELD BARRACKS, HI 96857
(808) 438-5555
Mailing address
334 HEARD AVE, BUILDING 556, SCHOFIELD BARRACKS, HI 96857
(808) 438-5555
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7062
AZ
1223G0001X
General Practice Dentistry
DT-2405
HI
1223P0700X
Prosthodontics
Primary
DT-2405
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156326
AHCCCS ID#
AZ
Enumeration date
12/27/2006
Last updated
04/28/2023
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