Organization
RUSSELL FAMILY DENTISTRY LLC
Active
Other names
Regan & Russell LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH EDMUND RUSSELL D.M.D. (MEMBER/DENTIST)
(207) 772-6966
Entity
Organization
Contact information
Practice address
495 WOODFORD STREET, PORTLAND, ME 04103
(207) 772-6966
(207) 761-0756
Mailing address
495 WOODFORD STREET, PORTLAND, ME 04103
(207) 772-6966
(207) 761-0756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154630000
MAINE CARE
ME
Enumeration date
12/03/2006
Last updated
05/12/2023
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