Individual
MR. EDWARD RILEY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
22629 TWAIN HARTE DR, TWAIN HARTE, CA 95383
(209) 586-2772
(209) 586-4612
Mailing address
22629 TWAIN HARTE DR, TWAIN HARTE, CA 95383
(209) 586-2772
(209) 586-4612
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
23457
CA
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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