Individual
MARK WILLIAM RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2815 VILLAGE WAY, TRENT WOODS, NC 28562-7351
(252) 633-4444
Mailing address
2815 VILLAGE WAY, TRENT WOODS, NC 28562-7351
(910) 638-8413
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11836
NC
Other
Enumeration date
05/01/2020
Last updated
06/03/2022
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