Individual
TRAVIS RAY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
594 MAIN ST N, MC KENZIE, TN 38201-1707
(731) 415-3084
Mailing address
594 MAIN ST N, MC KENZIE, TN 38201-1707
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10509
TN
Other
Enumeration date
05/30/2017
Last updated
05/30/2017
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