Individual
DR. RUSSELL A WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
910 MADISON AVE, STE 608, MEMPHIS, TN 38163-0001
(901) 448-6476
(901) 448-1390
Mailing address
910 MADISON AVE, STE 608, MEMPHIS, TN 38163-0001
(901) 448-6476
(901) 448-1390
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3320
TN
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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