Individual
DR. GREGORY SCOTT RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11200 RACETRACK RD STE 204, BERLIN, MD 21811-3808
(410) 208-3333
(410) 208-3330
Mailing address
11200 RACETRACK RD STE 204, BERLIN, MD 21811-3808
(410) 208-3333
(410) 208-3330
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
13423
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13423
MARYAND LICENSE NUMBER
MD
Enumeration date
01/23/2006
Last updated
12/23/2014
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