Individual
DR. ANDREW DAVID RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
130 PEACHTREE PLZ, BROWNSVILLE, TN 38012-2500
(731) 772-2107
(731) 772-1710
Mailing address
130 PEACHTREE PLZ, BROWNSVILLE, TN 38012-2500
(731) 772-2107
(731) 772-1710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7764
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016264
TENNCARE
TN
01
—
3149441
BLUE CROSS
TN
01
—
894752
UNITED CONCORDIA
TN
Enumeration date
10/23/2006
Last updated
07/09/2007
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