Individual
DR. PHILIP HOSTAGE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4313 MAIN ST., MANCHESTER, VT 05254
(802) 362-2151
Mailing address
PO BOX 586, MANCHESTER, VT 05254-0586
(802) 362-2151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
016-0000760
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
919-2393
—
VT
Enumeration date
03/15/2007
Last updated
07/08/2007
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