Organization
DIRK RUSSELL D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIRK RUSSELL (OWNER)
(770) 345-2010
Entity
Organization
Contact information
Practice address
8014 CUMMING HWY, SUITE 401, CANTON, GA 30115-9339
(770) 345-2010
(770) 345-0571
Mailing address
8014 CUMMING HWY, SUITE 401, CANTON, GA 30115-9339
(770) 345-2010
(770) 345-0571
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012158
KY
Other
Enumeration date
10/17/2006
Last updated
08/28/2007
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